Women having trouble conceiving may attribute it to a combination of factors, like age and hormonal issues. One factor that is often overlooked, however, is the impact of Autoimmune Disorders and Female Fertility Problems. Autoimmune diseases impact millions of women in their childbearing years, and they impact fertility, the health of a pregnancy, and women’s reproductive health.
The role of the immune system is to defend the body against disease and foreign malicious entities. In autoimmune diseases, the immune system starts to attack the body’s own healthy tissues and causes inflammation and damage of the organs. Depending on the autoimmune disease and how severe it is, these inflammatory responses can impact the ovulation and implantation process, the developing embryo, and the maintenance of a pregnancy.
Knowledge of autoimmune diseases and their impact on fertility can help women to pursue early diagnosis, treatment, and operative fertility planning. With the advancements in medicine today, autoimmune diseases no longer prevent women from having healthy pregnancies and active healthy infants.
What Are Autoimmune Diseases?
Autoimmune diseases occur when the immune system, which is supposed to defend the body against malicious entities, attacks the body’s own healthy tissues. There are over 80 conditions classified as autoimmune diseases, and a majority of them affect women.
Some autoimmune diseases that are commonly seen are:
– Rheumatoid arthritis
– Systemic lupus erythematosus (Lupus)
– Hashimoto’s thyroiditis
– Graves’ disease
– Celiac disease
– Type 1 diabetes
– Sjögren’s syndrome
– Antiphospholipid syndrome
– Multiple sclerosis
Because a majority of autoimmune diseases begin in the childbearing years, they may impact the reproductive health of women directly and/or indirectly.
Autoimmune Disorders and Female Fertility Problems
The link between autoimmune disorders and female fertility issues is multifaceted. The immune system is integral to the conception and maintenance of a pregnancy. The immune system out of balance can disrupt the reproductive process.
There are multiple ways autoimmune disorders can contribute to issues with fertility.
Chronic Inflammation
Chronic inflammation can adversely affect the reproductive system and the ovaries, as well as the inflammation of the uterine environment. Inflammation can lower the quality of an egg and hinder implantation of an embryo.
Hormonal Disruption
Many autoimmune diseases that affect the endocrine system and, in particular, the thyroid, can disrupt the production of hormones that are essential for the regularity of menstrual cycles as well as ovulation.
Damage to Reproductive Tissues
Some autoimmune diseases can diminish ovarian reserve by attacking reproductive tissues, resulting in premature ovarian insufficiency.
Increased Risk of Miscarriage
After conception, the risk of miscarriage increases in some autoimmune diseases as a result of antibodies disrupting the formation of the placenta and the circulation of maternal-fetal blood.
Common Autoimmune Disorders Linked to Fertility Problems
1. Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis is a leading autoimmune disease causing infertility in women and is an attack on the thyroid with resultant hypothyroidism.
Symptoms of Hashimoto’s include:
- Fatigue
- Weight gain
- Irregular periods
- Cold intolerance
- Hair loss
- Difficulty conceiving
With hypothyroidism, there is a greater risk of miscarriage and disruption of ovulation.
2. Lupus (Systemic Lupus Erythematosus)
Lupus is a multi-system disease that affects many organs including the kidneys, joints, skin and blood vessels.
Women with active lupus may have:
- Irregular menstrual cycles
- Reduced fertility
- Pregnancy complications
- Miscarriage
- Preterm birth
- Preeclampsia
The safest time to become pregnant is when lupus has been inactive for six months.
3. Antiphospholipid Syndrome (APS)
APS is primarily a blood-clotting autoimmune condition that triggers recurrent pregnancy loss.
Things women with APS commonly experience:
- Multiple miscarriages
- Failed embryo implantations
- Insufficient placenta
- Stillbirths
- Blood clots
The prognosis for pregnancy improves greatly with the early diagnosis of APS and the use of blood thinners.
4. Celiac Disease
The immune system’s reaction to gluten results in damage to the intestinal tract in Celiac Disease. This results in malabsorption of nutrients.
The invading gluten may result in:
- Delayed development of puberty
- Irregular menstrual cycles
- Infertility
- Recurrent miscarriage
- Nutritional deficiencies
In Celiac disease, fertility can be made possible by adherence to a gluten free diet.
5. Rheumatoid Arthritis
Though primarily a joint disease, the chronic inflammation of Rheumatoid Arthritis and the use of some antifolate medications may affect fertility.
Some women experience:
- Delayed conception
- Reduced Ovarian Reserve
- Challenges in Pregnancy planning
- Fertility concerns related to Medication
Improved reproductive outcomes may be possible with the appropriate management of the disease.
Symptoms That May Suggest an Autoimmune Cause of Infertility
Because many autoimmune diseases progress in a way that can be difficult to identify, the diagnosis of these diseases is often quite delayed.
Women with the following symptoms in addition to infertility should see a Fertility Specialist:
– Abnormal menstrual cycle
– Recurrent miscarriages
– Unexplained infertility
– Chronic Fatigue
– Joint Pain
– Persistent muscle aches
– Skin rashes
– Dry eyes or dry mouth
– Thyroid Disease
– Gastrointestinal distress
– Unexplained fluctuations in body weight
The identification of these symptoms allows for a diagnosis and treatment to be advanced.
Do Autoimmune Diseases Cause Recurrent Miscarriages?
The answer is yes, some autoimmune disorders that are particularly difficult to manage, may lead to recurrent miscarriage.
The immune system has the potential to:
– Attack developing fetuses
– Harm placental tissue
– Generate blood clots in placental vessels
– Cause abnormal inflammation
– Decrease the blood supply available to the fetus
The following diseases are particularly linked to pregnancy loss:
– Antiphospholipid syndrome
– Lupus
– Autoimmune thyroid disease
– Some rare immune diseases
After the right medical treatment, miscarriage rates are greatly reduced.
Diagnosis of Autoimmune Disorders with Infertility
Fertility diagnoses are completed together with reviews of immune system function.
Necessary diagnostic tests may include:
Blood Tests
– Antinuclear antibodies (ANA)
– Thyroid antibodies
– Anti-thyroid peroxidase antibodies
– Antiphospholipid antibodies
– Rheumatoid factor
– Anti-CCP antibodies
– ESR and CRP
Hormone Tests
– TSH
– Free T4
– LH
– FSH
– Estradiol
– Progesterone
– AMH
Imaging
Assess Ovarian Reserve and the Uterus, Fallopian tubes, and the Endometrial lining via Ultrasound
A total assessment of fertility is completed to ensure all factors are accounted for.
Treatment of Autoimmune Disorders and Infertility in Women
The treatment is reliant on the autoimmune disorder, its severity, and the goals in relation to pregnancy.
Disease Control
The control of the autoimmune disease to the time of conception greatly improves the likelihood of pregnancy.
Among the treatments are:
– Anti-inflammatory medications
– Immunosuppressive therapy
– Biologic agents
– Thyroid hormone replacement
Adjustment of treatment is the prerogative of the medical team prior to the time of pregnancy.
Fertility Treatments
Women who struggle to conceive naturally may benefit from:
– Ovulation induction
– Intrauterine insemination (IUI)
– In vitro fertilization (IVF)
– Intracytoplasmic sperm injection (ICSI)
Assisted reproductive technologies help many women with autoimmune disorders to conceive successfully.
Blood-Thinning Therapy
Antiphospholipid syndrome patients may be prescribed:
– Low-dose aspirin
– Low-molecular-weight heparin
These medications help thin the blood so that pregnancy is more likely to be successful.
Nutritional Management
Nutrition helps to balance the immune system and is important for reproductive health.
Physicians may prescribe:
– Folic acid
– Vitamin D
– Iron
– Omega-3 fatty acids
– Calcium
– Selenium (only if needed)
Celiac disease requires strict gluten avoidance to help heal the intestines.
Lifestyle Changes That Support Fertility
A healthy lifestyle can help to improve the outcome of medical interventions.
Suggestions include:
– Reach and maintain a healthy weight.
– Follow an anti-inflammatory diet with a lot of fruits, vegetables, whole grains, lean proteins, and healthy fats.
– Regular exercise, but avoid over-training.
– 7 to 9 hours of sleep.
– Stress management with yoga, meditation, or counselling.
– No smoking, and limit alcohol.
– Avoid excessive ultra-processed and sugary foods.
All of these changes can improve overall and reproductive health.
Pregnancy Planning with Autoimmune Disorders
Many women with autoimmune disorders can conceive with proper planning.
Recommendations:
– Gain control over the disease before conceiving
– Engage a rheumatologist and a fertility specialist
– Assess medications
– Regularly check thyroid levels
– Have frequent prenatal appointments
– Control blood sugar and blood pressure
– Assess fetal growth
The more specialities included in care, the better the results.
Can Autoimmune Disorders Prevent Women from Having Healthy Babies?
Not really. Autoimmune disorders can add risks to a pregnancy, but with proper care, women can have healthy pregnancies.
Successful outcomes rely on:
– Early detection
– Good control of the disease
– Safe medications
– Regular checks of the condition
– Personalized fertility care
– Careful consideration and coverage of prenatal needs
The field of reproductive medicine is improving as more advances are made in the area and as the control of autoimmune disorders is better.
When to Seek Help from a Fertility Specialist?
If you have tried to conceive regularly for the last twelve months (or six months if older than 35), had repeated pregnancy losses, have an irregular menstrual cycle, an autoimmune disorder, a thyroid condition, a chronic inflammatory condition, a family history of autoimmune disorders, and/or have symptoms of a chronic inflammatory condition, then you should seek the help of a fertility specialist.
Better early detection is the key to improved outcomes in fertility.
Conclusion
In reproductive medicine, the link between autoimmune disorders and female infertility is becoming widely accepted. Autoimmune disorders can affect the entire reproductive process; however, having an autoimmune disorder doesn’t mean you can’t conceive. Through early diagnosis and the individualized management of the disease, women are able to become pregnant and have successful pregnancies. If you have an autoimmune disorder and want to conceive, it is recommended that you seek medical advice as this can greatly improve your chance of conceiving.
