Adverse Pregnancy Outcomes in an IVF Patient with Anti-Synthetase Syndrome: Insights From a Rare Case

Mengjie He,1,* Xiaoyu Yu,2,* Li Wang,2 Rong Li,2 Xiaoju Zhou,3 Erniu Jike,3 Jiuzhi Zeng,2 Fei Wang1 1Department of Clinical Pharmacy, Sichuan Provincial Maternity and Child Health Care Hospital, Sichuan Provincial Women’s and Children’s Hospital, The Affiliated Women’ s and Children’s Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China; 2Reproductive Medicine Center, Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Sichuan Provincial Women’s and Children’s Hospital, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China; 3School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiuzhi Zeng, Reproductive Medicine Center, Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Sichuan Provincial Women’s and Children’s Hospital, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China, Tel/Fax +86-28-65978242, Email [email protected] Fei Wang, Department of Clinical Pharmacy, Sichuan Provincial Maternity and Child Health Care Hospital, Sichuan Provincial Women’s and Children’s Hospital, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, People’s Republic of China, Tel/Fax +86-28-65978526, +86-28-65978526, Email [email protected]: Anti-synthetase syndrome (ASS) is a rare autoimmune condition characterized by the presence of anti-aminoacyl tRNA synthetase (ARS) antibodies and systemic features such as interstitial lung disease and myositis. Although autoimmune disorders are known to affect fertility, the impact of ASS on assisted reproductive technology (ART) outcomes remains largely unexplored. We present the case of a 36-year-old woman with primary infertility and no prior autoimmune diagnosis. She underwent six in vitro fertilization (IVF) cycles marked by recurrent fertilization failure, cleavage-stage arrest with high fragmentation and poor grading and oocytes exhibiting a waxy zona pellucida (ZP). Her diminished ovarian reserve (DOR) (anti-Müllerian hormone: 0.351 ng/mL; antral follicle count: 5) was documented prior to ART. Following a rare successful embryo transfer, she developed severe ASS at 20 weeks of gestation, characterized by acute interstitial lung disease (ILD), anti-PL-12 antibody positivity, and myositis. These conditions progressed to life-threatening complications, ultimately necessitating pregnancy termination. This case suggests a possible link between ASS and ovarian dysfunction, potentially mediated by autoimmune injury to follicular structures, cytokine dysregulation, or anti-zona pellucida antibody interference. Moreover, pregnancy-associated immune shifts may exacerbate latent autoimmune activity. Screening for anti-synthetase antibodies could be beneficial in patients with unexplained infertility or recurrent ART failure.Keywords: anti-synthetase syndrome, assisted reproduction, infertility, ovarian reserve, autoimmune infertility, pregnancy complications