Lupus is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues, causing inflammation and damage. Concerns about family planning, fertility, and pregnancy are common for individuals with lupus. While lupus can impact reproductive health, it does not universally cause infertility; many people with lupus have successful pregnancies. Understanding its influence on fertility and how to support reproductive goals is important for those considering a family.
How Lupus Affects Fertility
Lupus can affect fertility through various direct and indirect mechanisms. Chronic inflammation can influence reproductive organs like the ovaries and uterus, or disrupt the delicate balance of hormones required for ovulation. This autoimmune activity can sometimes lead to the immune system mistakenly attacking reproductive cells, such as oocytes or the corpus luteum, which is essential for preparing the uterus for implantation.
Antiphospholipid syndrome (APS), a significant condition associated with lupus, can cause blood clots, affecting placental blood flow and increasing recurrent miscarriage risk. If lupus affects the kidneys, lupus nephritis, severe kidney disease, can impair reproductive function. Premature ovarian insufficiency (POI), where ovaries stop releasing eggs before age 40, can also occur, making conception more difficult. Lupus may also affect male fertility by impacting sperm quality or production.
Medications and Reproductive Health
Certain medications used to manage lupus can influence reproductive health. Immunosuppressants like cyclophosphamide can significantly impact ovarian reserve in females, potentially leading to premature ovarian failure. For males, these drugs may affect germ cell production, impacting sperm count and quality.
Corticosteroids can disrupt hormonal cycles, although their effect on fertility is generally less severe than powerful immunosuppressants. Non-steroidal anti-inflammatory drugs (NSAIDs) might interfere with ovulation if taken around conception.
Conversely, some lupus medications are generally safe for conception and pregnancy. Hydroxychloroquine is often continued during pregnancy to control disease activity. Consulting healthcare providers allows for a review of current medications and adjustments to ensure reproductive safety while maintaining lupus control.
Navigating Pregnancy with Lupus
Successfully navigating pregnancy with lupus largely depends on achieving stable disease control before conception. Healthcare providers typically recommend lupus activity be low or in remission for at least six months prior to attempting pregnancy to minimize risks and create a more favorable environment.
Despite careful planning, pregnancy in individuals with lupus carries certain potential complications. Risks include preeclampsia, preterm birth, and fetal growth restriction. Neonatal lupus, where parental antibodies pass to the baby, can cause temporary skin rashes or heart problems.
Close monitoring by a specialized healthcare team is essential throughout pregnancy. This team often includes a rheumatologist and a high-risk obstetrician. They work collaboratively to manage potential lupus flares and address emerging complications.
Strategies for Family Planning
Proactive family planning is important for individuals with lupus considering parenthood. It involves pre-conception counseling with healthcare providers, including a rheumatologist and an obstetrician-gynecologist, ideally several months before attempting to conceive. This allows for a thorough assessment of lupus activity and overall health.
During these consultations, medications are carefully reviewed and adjusted to pregnancy-compatible alternatives while maintaining disease control. Ongoing management of lupus activity and treatment of flares are also important for a healthy pregnancy.
For individuals whose lupus treatments might affect future fertility, options like egg or embryo freezing can be discussed. Adopting a healthy lifestyle, including balanced nutrition and stress management, supports reproductive health. Building a strong support system, involving healthcare teams, family, and support groups, provides assistance throughout the family-building journey.