Reproductive health in women with ankylosing spondylitis: contraception and fertility. A narrative review

Objective: The knowledge of ankylosing spondylitis is rising, and more and more attention is being paid to the diagnosis of this pathology in females. The purpose of this narrative review is to emphasize the role of reproductive health in women with ankylosing spondylitis, with particular attention to contraception and fertility. Methods: A comprehensive review of the literature was performed to evaluate the reproductive health of women with ankylosing spondylitis. Results: Oral contraception has been shown to be safe in women with ankylosing spondylitis, with no contraceptive benefits that should be evaluated during counseling. In the literature, there is no strong data regarding fertility in women with ankylosing spondylitis. It seems that these women may have impaired fertility due to reduced ovarian reserve, pharmacological treatments, and reduced sexual activity due to the concern that offspring may contract the disease. A multidisciplinary approach is needed in these women to ensure an adequate evaluation of sexual activity as an important aspect of quality of life and to counsel regarding family planning to address patients' concerns on contraception, fertility desire, and fertility preservation. Conclusions: Lifestyle factors should be investigated to improve fertility and disease activity without medications. Further trials are needed to investigate the reproductive health of women with ankylosing spondylitis.