In Vitro Fertilization (IVF) is a fertility treatment where an egg is combined with sperm outside the body. Autoimmune diseases, such as rheumatoid arthritis or lupus, occur when the body’s immune system mistakenly attacks healthy tissues. Patients often wonder if the intensive hormonal stimulation and procedures involved in IVF could trigger such an immune system malfunction. This concern is valid, given the known link between hormones and immune function.
Current Research Linking IVF and Autoimmunity
Large-scale epidemiological studies investigate the long-term health outcomes of women who undergo IVF, looking for an association with autoimmune conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). Extensive population data suggests that IVF treatment does not increase the risk of developing systemic autoimmune diseases.
One study compared the incidence of systemic autoimmune rheumatic diseases (SARD) in fertile women, women with infertility who conceived naturally, and women who used fertility treatments. Researchers found that women diagnosed with infertility who did not use fertility treatments were 25% more likely to develop SARD. Women who utilized IVF did not show this elevated risk.
This suggests that the underlying infertility itself, rather than the IVF procedure, is the factor linked to a higher risk of autoimmunity. The association is generally viewed as a correlation based on pre-existing risk, not direct causation from the treatment.
The Role of Pre-existing Infertility Factors
The primary challenge in linking IVF to autoimmune disease is separating the effect of the treatment from the patient’s health status that necessitated the treatment. Many conditions causing infertility are characterized by chronic inflammation or immune system dysregulation.
Infertility Conditions Linked to Autoimmunity
Conditions frequently found in women seeking IVF include endometriosis, Polycystic Ovary Syndrome (PCOS), and premature ovarian insufficiency (POI). Endometriosis involves chronic inflammation and immune cell activity, which is common in autoimmune processes. POI, a cause of early menopause, is linked to an underlying autoimmune component in approximately 20% of cases. PCOS, a hormonal disorder, is often associated with a higher prevalence of autoimmune thyroiditis, affecting an estimated 18% to 40% of women with the condition.
These pre-existing conditions may already predispose a patient to an autoimmune diagnosis, acting as a confounding variable in research studies. The presence of specific autoantibodies, such as antiphospholipid antibodies, is also more common in infertile women, even without a formal diagnosis of a systemic autoimmune disease. The evidence points to the underlying causes of infertility as the more significant risk marker for future autoimmune conditions.
Hormonal and Immunological Changes During Treatment
The IVF process involves controlled ovarian stimulation (COS), which temporarily introduces high levels of exogenous hormones, primarily estrogen and progesterone, to stimulate egg production. These steroid hormones interact significantly with the immune system, which fuels the concern about triggering autoimmunity.
During COS, the high levels of hormones can alter the immune environment within the reproductive tract. Gonadotrophin stimulation can change the immune cell profile and the concentration of inflammatory signaling molecules, called cytokines. However, these changes are often localized to the ovaries and are temporary, resolving shortly after the stimulation phase ends.
The observed immune system changes are generally transient and do not progress to a systemic clinical autoimmune condition. There is no substantial evidence that this temporary hormonal manipulation causes a new, long-term autoimmune disease in the absence of a pre-existing genetic susceptibility.