Autoimmune diseases can significantly impact fertility as the immune system can attack reproductive tissues, triggering chronic inflammation, impairing egg or sperm quality, or disrupting hormones. Common effects include early ovarian failure, embryo implantation failure, and recurrent pregnancy loss and are often seen in conditions like lupus, Hashimoto’s, and antiphospholipid syndrome.
Understanding Autoimmune Disorders and Fertility
Autoimmune disorders happen when the immune system mistakenly attacks healthy cells instead of harmful invaders. Many of these conditions can affect people of reproductive age and may influence fertility, pregnancy outcomes, and reproductive planning.
Common Autoimmune Conditions Impacting Fertility
Several autoimmune diseases can affect fertility and pregnancy, including:
- Systemic Lupus Erythematosus (Lupus): can damage organs and increase miscarriage risk.
- Rheumatoid Arthritis: chronic inflammation can affect reproductive tissues, including the uterine lining.
- Thyroid Disorders (e.g., Hashimoto’s, Graves’): affect hormone balance crucial for ovulation.
- Antiphospholipid Syndrome: antibodies interfere with blood flow to the uterus and placenta, increasing miscarriage risk.
- Coeliac Disease: inflammation and nutrient malabsorption can disrupt reproductive health.
- Type 1 Diabetes: hormonal imbalances and blood vessel damage can impair fertility.
- Multiple Sclerosis: impacts nervous system functioning, and as the brain controls hormone release, it can affect fertility.
How Autoimmune Diseases Affect Fertility
- Chronic inflammation: constant inflammation, a hallmark of autoimmune diseases, acts as a “toxic” environment to fertility, reducing egg quality, hindering sperm production, and making the uterus less receptive to embryo implantation.
- Targeting reproductive tissues: the immune system may produce antibodies that mistakenly attack ovaries, the uterine lining, or sperm.
- Hormonal imbalances: conditions such as Hashimoto’s thyroiditis can affect the thyroid or pituitary glands, leading to irregular menstrual cycles and ovulation issues.
- Premature ovarian failure: autoimmune conditions can cause the ovaries to cease functioning prematurely, reducing the egg supply.
- Increased pregnancy risks: these diseases can raise the risk of pregnancy complications such as preeclampsia, gestational diabetes, preterm birth, and intrauterine growth restriction (when a foetus does not grow at the expected rate). Antiphospholipid syndrome (APS) specifically can cause blood clots in the placenta, leading to recurrent miscarriages or stillbirth.
- Medication side effects: certain treatments for autoimmune diseases, particularly chemotherapy agents like cyclophosphamide for severe cases, can negatively impact fertility by damaging ovarian function and immunosuppressants and corticosteroids may temporarily reduce fertility or need adjustment before conception.
Managing Autoimmune Disorders While Trying to Conceive
While active, uncontrolled disease increases risks, many individuals with managed autoimmune diseases can successfully conceive. For individuals with an autoimmune condition who are planning a pregnancy, effective management and specialist care can improve fertility outcomes:
- Specialist consultation: see a rheumatologist or endocrinologist and a fertility specialist before attempting conception. They can assess your condition, adjust medications for pregnancy safety, and advise on timing and treatment plans.
- Remission: doctors typically recommend achieving stable remission for at least 3 to 6 months before trying to conceive.
- Achieving optimal health: work with your healthcare team to control disease activity before trying to conceive. This often involves medication review, stress management, a balanced anti-inflammatory diet, and moderate exercise.
- Preconception counselling: preconception counselling helps individuals understand risks, assess genetic factors, and receive personalised guidance for pregnancy planning.
- Monitor menstrual cycles: tracking cycles helps identify fertile windows, especially important if autoimmune disorders cause irregular periods. Methods include ovulation kits or tracking basal body temperature.
- Fertility treatments: if natural conception is challenging, treatments like ovulation induction with timed intercourse (OI-TI), intrauterine insemination (IUI), or in vitro fertilisation (IVF) may be recommended.
Pregnancy with Autoimmune Disorders
Women with autoimmune disorders may face higher risks of complications such as:
- High blood pressure with organ damage (preeclampsia)
- Diabetes developing during pregnancy (gestational diabetes)
- Premature birth
- Intrauterine growth restriction
Pregnancy in individuals with autoimmune diseases requires close, coordinated care involving obstetricians, maternal-foetal medicine (MFM) specialists, endocrinologists and rheumatologists. Some autoimmune conditions may improve during pregnancy (e.g., rheumatoid arthritis), while others may worsen (e.g., lupus). Doctors will monitor both disease activity and foetal development throughout pregnancy.
Outlook and Support
While autoimmune diseases can pose challenges to fertility and pregnancy, many individuals with these conditions can successfully conceive and carry a healthy pregnancy with personalised medical care and planning. Early communication with specialists and effective management strategies are key to optimising outcomes.
This blog by Thomson Medical provides more details on the subject and offers practical support for optimising your health for conception.
