An autoimmune disease is a condition where the body’s immune system mistakenly attacks its own healthy cells and tissues, leading to a wide array of symptoms that can affect various organs. Fertility is the natural capability to conceive a child. The systemic effects of an autoimmune condition can extend to the reproductive system, creating a complex connection between these diseases and the ability to have children for both women and men.
How Autoimmune Diseases Affect Female Fertility
The connection between autoimmune diseases and female fertility involves chronic inflammation and autoantibodies. Systemic inflammation, common in autoimmune conditions, can disrupt the hormonal balance governing the menstrual cycle and ovulation. This inflammation may also directly affect the ovaries, leading to a reduced ovarian reserve, which is the quantity and quality of a woman’s eggs. A diminished number of healthy eggs can shorten the window for conception.
Autoantibodies can also cause fertility challenges by mistakenly targeting reproductive organs like the ovaries or the uterine lining (endometrium). This can interfere with the implantation of a fertilized egg. The presence of certain autoantibodies is linked to higher rates of implantation failure and miscarriage.
Specific autoimmune diseases present distinct fertility challenges. Hashimoto’s thyroiditis can cause hypothyroidism, which disrupts menstrual cycles and ovulation. Systemic lupus erythematosus (SLE) can cause inflammation affecting the ovaries and uterus, increasing the risk of miscarriage and pregnancy complications. Conditions like autoimmune oophoritis directly target the ovaries, causing damage that can result in premature menopause.
How Autoimmune Diseases Affect Male Fertility
Autoimmune diseases can also affect the male reproductive system, with systemic inflammation being a primary factor. This chronic inflammation can disrupt sperm production (spermatogenesis). The results can include a lower sperm count, reduced sperm motility, or an increase in abnormally shaped sperm, all of which hinder conception.
Antisperm antibodies (ASAs) present another immunological threat by specifically targeting sperm and impairing their function. ASAs can cause sperm to clump together (agglutination), hindering their movement through the female reproductive tract. They can also interfere with the sperm’s ability to penetrate the egg, preventing fertilization. The presence of these antibodies is a recognized cause of immunological infertility in men.
Certain autoimmune conditions are commonly associated with male infertility. Men with systemic lupus erythematosus (SLE) may have a higher incidence of ASAs. Autoimmune thyroid disease can lead to hormonal imbalances that negatively affect sperm production. Autoimmune diseases can also cause inflammation in the testicles (autoimmune orchitis), which directly damages sperm-creating tissues.
The Impact of Autoimmune Medications on Conception
Medications for autoimmune diseases can significantly impact fertility and pregnancy. Some treatments are incompatible with conception and require careful management. For example, methotrexate, a common drug for rheumatoid arthritis, causes birth defects and must be stopped well before trying to conceive. Cyclophosphamide, used for severe conditions, can increase the risk of premature ovarian failure.
Many medications are considered safe for use during the preconception period and pregnancy. Hydroxychloroquine, used for lupus and rheumatoid arthritis, is considered safe to continue. Certain biologic drugs that target specific parts of the immune system may also be appropriate. The decision to adjust medication is individualized and depends on the drug, disease severity, and the patient’s health.
A person should never stop or change their autoimmune medication without consulting their doctor. An unmanaged disease flare-up during the preconception period or pregnancy poses risks to both the parent and the developing fetus. A healthcare provider can create a treatment plan that balances disease control with the goal of a healthy pregnancy.
Preconception Planning and Management
Preconception planning is an important step for individuals with autoimmune diseases who wish to start a family. This planning involves forming a multidisciplinary care team. This team includes a rheumatologist, a reproductive endocrinologist (fertility specialist), and a maternal-fetal medicine specialist (high-risk pregnancy expert). This approach ensures all aspects of the person’s health are considered.
The goal of preconception management is to achieve disease remission or low disease activity for at least six months before trying to conceive. This stability reduces the risk of pregnancy complications like preeclampsia, preterm birth, and fetal growth restriction. Achieving remission involves adjusting medications to ones that are effective for disease control and safe for pregnancy.
Certain lifestyle factors can support overall health and help manage the autoimmune condition. A balanced, anti-inflammatory diet rich in fruits, vegetables, and whole grains may be beneficial. Managing stress with techniques like mindfulness or gentle exercise can also be helpful, as stress can exacerbate symptoms. These adjustments help maintain a stable state before conception.
Navigating Pregnancy and Postpartum
Pregnancy and the postpartum period require specialized care for individuals with autoimmune diseases. Heightened monitoring during pregnancy is necessary to watch for potential complications. These can include an increased risk of preeclampsia, gestational diabetes, and preterm birth. Regular check-ups with the care team help manage these issues early.
Many women find their autoimmune symptoms improve during pregnancy due to natural shifts in the immune system. However, some may still experience disease flares. The postpartum period is a time of increased risk for flares, as hormone levels change and the immune system returns to its pre-pregnancy state.
A postpartum care plan is an important part of the management strategy. Developed with the medical team, this plan outlines how to monitor for flares and safely adjust medications, especially if breastfeeding. This allows for prompt intervention, helping the new parent manage their health while caring for their newborn.