I have psoriasis. Can I consider IVF at 36?

Question

Hello doctor,

I am 36 and have been battling psoriasis for eight years, mostly on my scalp, elbows, and recently around my lower back. Lately, my condition has worsened, maybe due to stress and lack of sleep.

I am also planning to start IVF in a few months, and my dermatologist suggested starting biologic therapy like Adalimumab. I am scared that it could interfere with conception or harm the fetus if I conceive.

So, I am looking for your opinions on the following:

Are biologics or Methotrexate safe before or during pregnancy?
Can hormonal issues cause a skin flare-up terribly right before my period?
Should I delay IVF until psoriasis stabilizes?
I have also noticed stiffness in my fingers and mild joint pain, so could this mean psoriatic arthritis?
Are there any natural or diet-based ways to reduce inflammation that are also safe for someone planning a pregnancy?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns, and I appreciate you reaching out for clarity while planning pregnancy and IVF (in-vitro fertilization). Managing psoriasis alongside fertility treatment requires careful coordination, and I will address each of your concerns below.

Biologic medications such as Adalimumab (Humira) belong to the class of TNF-alpha (Tumor necrosis factor) inhibitors. Among systemic treatments, these are generally considered safer options for women planning pregnancy, especially when compared to older agents like methotrexate or acitretin.

Adalimumab can be used up to conception, and in certain cases, it may be continued during early pregnancy if disease control is essential.

Current guidelines from organizations such as the American Academy of Dermatology (AAD) suggest discontinuing Adalimumab toward the end of the second trimester (approximately weeks 20 to 28), as placental transfer increases significantly later in pregnancy.

Methotrexate is strictly contraindicated in pregnancy and pregnancy planning, as it is teratogenic and can cause fetal malformations and miscarriage.

It must be stopped at least three months before conception, and folic acid supplementation is essential during and after discontinuation.

Methotrexate should be completely avoided if you are planning IVF or pregnancy.

Yes, hormonal changes, particularly the drop in estrogen and progesterone before menstruation, can trigger or worsen psoriasis flares.

This premenstrual exacerbation is quite common in women with inflammatory and autoimmune skin conditions. Stress and sleep deprivation further aggravate flares by increasing cortisol and inflammatory cytokines.

Maintaining consistent sleep, stress-reduction practices (such as yoga, gentle exercise, or mindfulness), and timely use of topical therapies or phototherapy can help manage hormonally driven flares safely.

Should you delay IVF? If your psoriasis is mild to moderate and stable, you may proceed with IVF while maintaining disease control using topical treatments, phototherapy, or selected biologics.

However, if the disease is severe, unstable, or associated with significant systemic inflammation, it is advisable to stabilize it first. Chronic inflammation and stress can negatively affect fertility and IVF outcomes.

Close coordination between your skin and fertility specialist is needed. In many cases, biologics are continued through IVF until conception, with individualized reassessment thereafter.

I hope this helps. Please feel free to follow up with more queries.

Thank you.