Fertility and Autoimmune Disease
Is there a connection between fertility difficulties and autoimmune conditions?
One of the many frustrations about having an (or multiple) autoimmune disease is the frequency with which you are told, “We just don’t know;” “The conditions vary greatly among patients so we can’t predict that for you;” “The research provides conflicting data…” It can make a patient feel alone and confused.
Unfortunately, issues of fertility, pregnancy and miscarriage, yet again, fall into the big, messy stew of the poorly understood aspects of autoimmunity. The good news, though, is that providers who deal with reproductive difficulties (fertility, pregnancy loss) really are very-well accustomed to helping couples overcome the challenges, even when the cause of the problem is poorly understood.
Which specific autoimmune diseases are known to impact fertility?
We know that certain autoimmune diseases are associated with specific reproductive challenges. Type 1 diabetes, lupus and the associated anti-phospholipid syndrome, anti-thyroid antibodies and even an elevated ANA (anti-nuclear antibody, a non-specific marker of inflammation) in the absence of a clear disease process, have all been associated with both difficulty conceiving (infertility is defined at no conception after one full year of trying) and recurrent pregnancy loss (defined as >3 miscarriages).
We do not know how the almost 80 other autoimmune conditions might affect both female and male fertility but it is very reasonable to think that if the immune system is ‘attacking’ one system, it could easily be also attacking the reproductive system. In these instances, providers do the best they can to treat and stabilize the autoimmune conditions and to, then, employ all available options toward achieving and maintaining pregnancy.
Are there any tests available to tell me if I’ll have infertility or recurrent pregnancy loss before I start trying to conceive?
If you have never tried to get pregnant and your autoimmune condition is generally well-controlled, it is likely that your provide will suggest you attempt conception first. After all, many, many people with autoimmune disease have perfectly straight-forward pregnancies. If you’ve had a history of blood clots, you’ve got lupus (SLE) or you’ve got close family members with antiphospholipid syndrome (an immune mediated clotting disorder), your provider might suggest testing for this.
Will any of the common fertility drugs cause flares in autoimmune symptoms?
Many women report autoimmune flares during specific times in their menstrual cycle (i.e. during hormone fluctuations), so it is interesting to wonder if fertility drugs (usually hormones) could cause flares, as well. There are medically documented cases of fertility treatment (i.e. ovarian stimulation) causing flares in lupus (SLE), and anecdotal reports online of patients who state they had disease flare during their fertility treatments, as well. These reports seem to be in a quite small minority of patients, however. This is simply a subject that needs to be assessed on a case by case basis with the teamwork of a fertility specialist and a rheumatologist or endocrinologist working with the patient to find the safest, most-effective and best tolerated combination of medications.
Is prednisone safe to take while I’m trying to conceive or when I’m pregnant?
Steroids are used very commonly for many different autoimmune diseases. Generally, they are considered safe while you are trying to conceive. They should be avoided, whenever possible, during the first trimester. Thereafter, if they are necessary, they should be used at the lowest dosage for the shortest time possible. The risks of steroids are mainly related to low birth-weight infants; steroids, when used as described, have not been shown to cause any major fetal complications.
Questions for your doctor:
- With my history of autoimmune disease, would you still recommend trying to conceive for a full year before investigating further (this is particularly important if you’re over the age of 35)?
- How can my pain be treated safely while I’m pregnant?
- What can I expect during pregnancy and post-partum – improvement or worsening of symptoms?
About the Author
Kathi Kuntz, RN, MSN holds a Bachelor’s and a Master’s Degree in Nursing from the University of Pennsylvania. Her specialization is in the healthcare of women and her graduate research thesis was on autoimmune disease in pregnancy. She has over ten years of clinical practice experience. Currently, Kathi is on an adventure living and traveling with her husband and two young sons in Australia.
This blog post was originally published by AutoimmuneMom.com, written by Kathi Kuntz, RN, MSN, and first published on Nov 27, 2012.
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