Autoimmune Disease and Infertility
Causes and Treatment Options for Autoimmunity
Dr. Gleicher explains autoimmune disorders and how they affect fertility.
Because abnormal immune function can affect fertility as well as miscarriage risk, affected women need two layers of treatment: a first, to conceive, and a second, to prevent pregnancy loss after conception. This is a very important point because it would not make sense to help them get pregnant only to see them experience a potentially preventable pregnancy loss.
What is an autoimmune disease?
The term autoimmune disease refers to a varied group of more than 80 serious, chronic illnesses that involve almost every human organ system. In all of these diseases, the body's immune system becomes misdirected, attacking the very organs it was designed to protect. About 75% of autoimmune diseases occur in women, most frequently during the childbearing years. Autoimmune diseases can affect connective tissue. (This is the tissue which binds together various tissues and organs.) It can also affect the nerves, muscles, endocrine system, and gastrointestinal system. There are many autoimmune diseases, with multiple sclerosis, Hashimoto’s thyroiditis, rheumatoid arthritis being some of the most common (for a more extensive list of common autoimmune diseases, see the chart below.
What causes autoimmune diseases?
Unfortunately, autoimmune diseases remain among the most poorly understood illnesses. It is thought that hormones play a role in inducing autoimmune diseases; some cases suddenly improve during pregnancy, others flare-up during, or after pregnancy. Yet, others may flare up only after menopause.
Autoimmune diseases also show a strong hereditary component, but mysteriously, can cluster in families as different conditions. For example, a mother may have lupus erythematosus; her daughter, scleroderma and her grandmother, rheumatoid arthritis. Ongoing research is attempting to shed more light on genetic, hormonal and environmental risk factors that contribute to the occurrences of autoimmune diseases.
How are autoimmune diseases diagnosed?
The diagnosis of an autoimmune disease is based on symptoms, findings from a physical examination, and results from laboratory tests. Specific autoimmune diseases are, at times, difficult to diagnose, especially in the early stages of the disease, when symptoms and laboratory data may not yet be specific enough. Although autoimmune diseases are usually chronic, the course they take is often unpredictable.
How are autoimmune diseases treated?
Since autoimmune diseases are often chronic, they may require lifelong care and monitoring, even when the person may look and feel well. Currently, few autoimmune diseases can be cured or made to disappear with treatment. However, many people with these diseases live relatively normal lives when they receive proper medical care.
How are autoimmune diseases treated for infertility?
CHR Publications on Autoimmunity
- Journal of Autoimmunity Reviewing the last 10 years of medical literature, the study found considerable data suggesting significant negative impact of autoimmunity on female reproductive success. Combining this finding with CHR's recent work on the FMR1 gene, the article points out the possibility that the FMR1 gene stands at the crossroad of ovarian reserve and autoimmunity.
Gestational dermatosis shortly after implantation associated with parental class II HLA compatibility and maternal immune activation: preliminary report of a prospective case series.Dermatology The case series reports on 7 couples who presented with typical skin rash occurring days after embryo implantation. All female partners reported clinically significant allergies and autoimmune findings, and all but one couple demonstrated class II HLA compatibility. The study speculates that the "implantation rash" may be a maternal immune response to embryo implantation in women with prior immune activation associated with class II HLA compatibility.
As the causes of autoimmune diseases are not well understood, it is not surprising that we still lack specific treatments for the various conditions. What we can treat are usually selected symptoms of diseases, which, at times, may include infertility. Indeed, mostly through Dr. Gleicher's work, we, in some women, have come to see infertility as a fairly typical early symptom of abnormal female autoimmune function.
Because of our special expertise in this area, CHR sees a large volume of women with clinically overt (but also sub-clinical, early) autoimmune diseases who suffer from infertility and/or pregnancy losses. The good news is that with aggressive treatment, most patients can conceive and deliver healthy children.
In a preliminary, though quite provocative, study published in 2006 in the Journal of Autoimmunity, Dr. Gleicher for the first time suggested that the risk to develop autoimmune disease may be influenced by the way children are being delivered: Cesarea section delivery may reduce the risk to offspring, while at the same time increasing the maternal risk to flare her condition.
For more information on Dr. Gleicher's research see Scientific Publications.
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Think an autoimmune disease may be a factor in your infertility? Our experts can help diagnosis the problem and create a personalized treatment plan for you. Contact us if you would like our preliminary opinion on your Next Steps.
Key Facts about Autoimmune disease and infertility
Common examples of autoimmune diseases
|Autoimmune diseases which affect the nervous system||Autoimmune diseases which affect the gastrointestinal tract|
|Autoimmune diseases of the hematological system||Autoimmune diseases which affect the endocrine glands|
|Autoimmune diseases which affect blood vessels||Autoimmune diseases of the skin|
Autoimmune diseases which affect multiple organs (also called connective tissue diseases) Autoimmune Diseases in Women Resources
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Written by Norbert Gleicher, MD
Last Updated: December 31, 2013