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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Cyclophosphamide (CYC) is an effective treatment for lupus nephritis but is associated with a risk of infertility, which limits its use in women of reproductive age. This study aims to describe a multi-center experience with CYC use and its impact on fertility among lupus nephritis patients in Saudi Arabia.
This retrospective observational study was conducted across three tertiary centers in different provinces of Saudi Arabia. Female patients aged ≥18 years with biopsy-proven lupus nephritis treated with CYC were included. Data were extracted from electronic medical records. The study was approved by the ethics committees at all participating institutions.
A total of 51 patients were included: 51% from King Abdulaziz University Hospital (Western Province), 43% from King Saud University Medical City (Central Province), and 6% from King Fahad Specialist Hospital (Eastern Province). The age range was 18–58 years, with a mean age of 36.5 years (SD: 10.3).
76.5% were Saudi nationals. Comorbidities included diabetes (4%), hypertension (31%), and antiphospholipid antibody syndrome (12%). Histological classes were as follows, class III (23.5%), class IV (70.5%), class V (4%), and class II (2%). Renal-limited disease was observed in 55%.
Regarding reproductive history, 19.5% had a successful pregnancy prior to CYC; 53% did not (pregnancy attempts unknown). 8% had a miscarriage prior to treatment.
At the time of CYC initiation, 47% were ≤25 years, 19.5% were 26–35, 16% were >35, and age was unknown in 17.5%. Regarding cyclophosphamide exposure, 55% received ≤3 g cumulative dose, 25.5% received >3–6 g, 17.5% received >6 g, and dose was unknown in 2%.
Regarding fertility preservation, GnRH agonists were used in 43%, and oocyte preservation in 8%.
Regarding fertility outcomes, premature ovarian insufficiency (POI), defined as sustained amenorrhea >12 months, occurred in 10%. Reversibility defined as return of menstruation within 3–12 months was seen in 8%.
Future pregnancies were reported and confirmed in 39% (20 patients), with, 16 live births, 8 cases of intrauterine growth restriction (IUGR), and 7 preterm deliveries.
Our results demonstrate that cyclophosphamide treatment does not invariably lead to infertility. In younger patients receiving lower cumulative doses, future pregnancies are possible, aligning with previous reports. Limitations of our study include the small sample size and potential underestimation of CYC safety due to unknown fertility intentions. Lack of pregnancy may reflect personal choice rather than confirmed infertility. Additionally, the effect of confounding factors that affect fertility, such as kidney disease and lupus itself, is also a limitation. We aim to expand this research by involving additional centers. Cyclophosphamide remains a viable treatment option, especially in severe lupus nephritis, and our findings contribute to the growing body of evidence supporting its use in selected patient populations.
