Content table
Wondering how your autoimmune disease affects fertility? Or think you may be struggling to conceive due to a potential autoimmune disorder?
Autoimmune conditions can make it harder to get and stay pregnant. There’s a higher rate of autoimmune disorders among women who go to fertility clinics than the general population.
All that said, having an autoimmune condition isn’t a dead end for getting pregnant or starting a family.
In some cases, more research is needed to fully understand how certain conditions impact fertility. But looking into your own immune health is a vital step in your family-building process.
Keep reading for an overview of how certain autoimmune conditions impact fertility. Plus, understand how you can manage your immune health if you’re trying to conceive (TTC)!
Key takeaways
- Having an autoimmune disease can impact both male and female fertility.
- The exact impact on fertility outcomes depends on many factors. These include: the particular condition, the severity of symptoms, and the treatment plan.
- It’s also important to ensure the medications you’re on are safe for conception and pregnancy.
- Many people living with autoimmune conditions are able to have a healthy pregnancy. But the right fertility treatment plan is vital!
- Talk to your healthcare provider sooner if you’re TTC. That way, you can start any preconception measures necessary for family-building.
Autoimmune issues and fertility
Here’s a look at how specific autoimmune conditions may impact female and male fertility.
How does Systemic Lupus Erythematosus (SLE) affect fertility?
Lupus and female fertility
About 1% of infertile women have lupus. Systemic lupus erythematosus is a chronic disease, autoimmune in nature, that mainly affects younger women. It involves symptoms like joint pain, kidney failure, and sensitivity to light.
Fertility challenges can arise in women with lupus due to:
- Taking medications that treat lupus symptoms. (Thankfully, newer treatments out there are less harmful for fertility and ovarian function)
- Disease-related symptoms (like pain and fatigue) that cause lower sex drive.
- Older maternal age due prolonged treatment
- Increased antiphospholipid antibodies which can interfere with ovarian function.
- Premature ovarian insufficiency (POI) or premature ovarian failure (POF).
- Diminished ovarian reserve (DOR) and lower anti-Müllerian hormone (AMH) levels.
- Irregular cycles and ovulation challenges. (especially if symptoms are flaring or if using steroids for treatment)
Know more : Primary Ovarian Insufficiency: Signs, Causes & Treatment
One study showed that 53% of lupus patients aged 18 – 40 had menstrual irregularity. And women under 18 who had active lupus symptoms struggled with absent periods (amenorrhea).
Women who conceive with lupus have an increased risk of pregnancy complications. This can include not being able to carry a pregnancy to term due to disease-related symptoms. One study found that 64% of lupus patients ended up having fewer children than they had originally wanted.
If you have lupus and you’re TTC now or in the future, talk to your doctor. They can help you manage your symptoms in a way that’s more supportive of your fertility journey.
Lupus and male fertility
Lupus can also impact men who are trying to conceive.
Here are some of the fertility challenges men with lupus may face:
- Damage to the testicles
- Hormonal changes
- The body’s autoimmune response
- Effects from treatment and medications
- Decreased testicular volume (caused by damage to the tubes that produce sperm)
- Poor sperm parameters (like low sperm count, decreased sperm volume, and motility)
- Increased LH and FSH levels that impact semen quality
- A higher rate of erectile dysfunction
- Anti-sperm antibodies (which kill off sperm)
How does thyroid disease affect fertility?
Thyroid disease and female fertility
When you have autoimmune thyroid disease, your immune system basically attacks your thyroid gland.
This can lead to:
- Hashimoto’s thyroiditis (hypothyroidism, aka underactive thyroid)
- Graves’ disease (hyperthyroidism, aka overactive thyroid)
Research shows that up to 15% of reproductive-age women struggle with thyroid disease.
Women with hypothyroidism can experience fertility challenges tied to:
- Disrupted ovulation
- Hormonal imbalances (including high prolactin levels and disrupted progesterone and estrogen balance)
- A higher rate of miscarriage after undergoing ART
Know more: Hypothyroidism and Pregnancy: How Thyroid Affects Fertility
And thyroid autoimmunity in general is associated with:
- An increased chance of early miscarriage
- Low birth weight or preterm birth
- Other pregnancy complications
For many women, thyroxine for thyroid hormone deficiency can improve fertility and pregnancy outcomes.
Thyroid disease and male fertility
Men who suffer from Hashimoto’s thyroiditis (HT) may experience symptoms that can interfere with their fertility.
Some of these challenges include:
- Hormonal imbalances (like slightly higher LH and FSH and potentially lower testosterone)
- Lower semen quality (including reduced sperm motility and impaired sperm morphology)
How does celiac disease affect fertility?
Celiac disease and female fertility
About 1 in 100 people in developed countries worldwide suffer from celiac disease. This is an autoimmune disease where gluten disrupts nutrient absorption. It can also damage the small intestine.
With or without treatment, celiac disease symptoms can impact fertility. In fact, a recent study showed that females struggling with unexplained infertility were 6 times more likely to have celiac disease.
Here are some of the fertility and pregnancy challenges linked to Celiac disease:
- Antibodies that disrupt the placenta
- A potential for increased blood clotting (microthrombus)
- A higher risk of stillbirth or recurrent miscarriages
- Intrauterine growth restriction (IUGR)
- Low birth weight or premature birth
- Less success with breastfeeding
These outcomes may sound overwhelming. But there is a silver lining! Treating your symptoms (like switching to a gluten-free diet), can improve fertility outcomes. Not to mention, reduce your uncomfortable symptoms!
Celiac disease and male fertility
Men with undiagnosed celiac disease can also face struggles when trying to conceive. Up to 7.8% of men with unexplained infertility have undiagnosed celiac disease.
Here’s how male fertility can be impacted with celiac disease:
- Lower sperm quality (including irregular shape and movement)
- Decreased sperm count (oligospermia)
- Antisperm antibodies
- Altered hormone levels (like lower dihydrotestosterone, which may impact prostate health)
Know more: Tips for Getting Pregnant with Low Sperm Count – Inito
Just as with women, for men who are TTC, fertility outcomes can improve once you adopt a gluten-free diet.
How do autoimmune rheumatic-related diseases (ARRD) affect fertility?
Rheumatoid arthritis and female fertility
More research is needed to understand how rheumatoid arthritis (RA) impacts fertility. But here are some potential struggles that can happen:
- Increased time to achieve pregnancy
- Reduced ovarian reserve
- Disrupted ovulation (potentially from inflammation or medications used to treat RA)
- Decreased sex drive due to pain, fatigue, or lower confidence
If you have RA and you’re trying to get pregnant, be sure to talk to your doctor or a fertility specialist. They can help you map out the best course of action based on your unique health history.
RA and male fertility
Men suffering from arthritis can also struggle with conceiving. They may experience:
- Hormonal disruptions
- Lower semen and sperm quality
- Varicocele (enlarged veins in the scrotum)
- Impaired testicular function
- Lower fertilization rates (possible due to antisperm antibodies)
If you’re a male who has RA, it’s a good idea to get a fertility exam and semen analysis. This will help inform you about next steps on your fertility journey.
How does antiphospholipid syndrome (APS) affect fertility?
Antiphospholipid syndrome (APS) can lead to pregnancy complications and blood clots.
Research is still ongoing to figure out the exact ways that APS affects fertility. But here are some potential issues that can happen:
- Disrupted implantation
- Implantation failure for IVF patients
- Reduced ovarian reserve
The best thing to do if you have APS is consult with a fertility specialist. They can run some personalized diagnostic tests for you to get a better picture of your fertility.
How does Behcet’s disease affect fertility?
People who suffer from Behcet’s disease experience a range of symptoms. Some of the common ones include ulcers, eye inflammation, and skin lesions.
As of now, there’s no research to suggest that Behcet’s disease leads to fertility challenges. That said, it is linked to pregnancy complications.
For example, studies show that women with Behcet’s disease have about double the rate of:
- C-sections (1.8 times higher)
- Preterm birth (2.2 times higher)
- Miscarriage (2.4 times higher)
And up to 12% of women with the condition are at risk for developing blood clots.
If you have Behcet’s disease and you’re trying to conceive, it’s vital that you talk to your doctor. Certain medications used to treat symptoms aren’t safe while pregnant. And a specialized doctor can support you in a family planning route that’s safe for you and your baby.
How does endometriosis affect fertility?
Endometriosis isn’t technically an autoimmune disease. But it involves chronic pain and inflammation as well as disruptions to the immune system. Hence why it’s worth mentioning here!
In a nutshell, it’s a condition in which uterine tissue grows outside of the uterus. And it affects nearly 10% of women of reproductive age. Some estimates claim that upwards of 40% of women experiencing infertility have endometriosis.
Here are some of the ways endometriosis can impact your fertility journey:
- Blocked fallopian tubes
- Disruptions to how the egg and sperm move inside the woman’s reproductive system
- Damage to sperm and eggs (due to all the inflamed tissue)
Know more: Getting Pregnant with Endometriosis: Success Stories
You’ve seen how individual autoimmune diseases can impact fertility. But next, let’s recap how autoimmunity in general can impact your fertility journey.
What are common causes of infertility in patients with autoimmune disorders?
Having an autoimmune disease can impact your ability to get pregnant for a variety of reasons. (Regardless of the specific condition!)
Some of these include:
- Symptoms related to the particular disease
- Inflammation that can impact reproductive functions
- Being older in age while TTC. (Due to stabilizing disease-related symptoms and medication regimens)
- Reduced sexual activity due to body image, mental health, pain, or fatigue
Any medications used to treat your autoimmune condition can also affect your fertility. More on this next!
How do autoimmune disease medications affect fertility?
Here’s how common medications taken for autoimmune conditions may impact fertility.
Medication | Impact on female fertility | Impact on male fertility |
NSAIDS (anti-inflammatory, pain relievers) | Can disrupt ovulation while on the medication | Can impact sperm count and sperm health, effects may go away once off the medication |
Corticosteroids (steroids) | Using them long-term can disrupt hormonal balance, menstrual cycle regularity, and ovarian function Women with RA taking steroids may take longer to get pregnant | Could lead to lower testosterone levels and can mess with sperm production |
Cyclophosphamide (immunosuppressant) | Higher dosages linked to: lower ovarian reserve, damaged follicles, and premature ovarian function (POF) These effects may be offset by additional therapies (like GnRH analogues) | Higher doses taken long-term more likely to impact sperm production, even causing low sperm count or irreversible infertility |
Methotrexate | Could lead to miscarriage if taken while pregnant | May increase testosterone levels |
While the above medications can impact fertility and pregnancy outcomes, there are others that may not. If you’re on any medications to treat an autoimmune disorder and you’re hoping to conceive, talk to your doctor!
And keep reading to see what can be done if you’re TTC while also managing an underlying condition.
How to manage autoimmune disorders when you’re TTC?
Tip 1: Make sure there’s coordinated communication between your healthcare team.
Any specialists that you see related to your autoimmune disease should be in the loop with your fertility specialist or OB-GYN. This is super important to ensure that all your desired health and fertility needs are being met.
Tip 2: Stick to healthy lifestyle habits.
Keeping a healthy weight, getting quality sleep and regular exercise, and limiting stress are vital for health. These habits can also help with keeping inflammation under control. Those with Celiac disease should switch to a gluten-free diet before TTC.
Tip 3: Get a preconception checkup as early on as possible.
Typically, the advice is to talk to a fertility specialist after 12 months of TTC if you’re under 35. And 6 months if you’re older than 35. But if you or your partner have an autoimmune condition, it may benefit you to seek expert fertility guidance sooner than that. If you’re a woman suffering from thyroid disease, during this checkup, it’s important to get a picture of your thyroid levels.
Tip 4: Be part of the decision-making process.
Quality healthcare is an important part of your fertility journey. But it’s equally as important for you to be as informed as possible. This way, you can feel more empowered in making decisions in your best interest. The more you understand your unique health markers, the better outcomes you can expect for yourself (and your future baby)!
Tip 5: Take advantage of windows when your symptoms are well-controlled.
You’ll want to plan your pregnancy for a time when your disease is well-managed. A good timeframe is 6 months or more of being in remission or having minor disease activity. This is especially important if you have conditions like lupus or rheumatoid arthritis. Timing conception properly can help you avoid higher risks of pregnancy complications.
And this is exactly where Inito can help you. The Inito Fertility Monitor tracks key fertility hormones–including estrogen, LH, PdG (a urine metabolite of progesterone), and FSH–to not only identify your most fertile days, but also confirm ovulation. This can help you understand your cycle better and time intercourse when your chances of conception are highest.
Tip 6: Speak to your healthcare provider about your medications
This goes along with tip 1! It’s important that all of your healthcare providers are aware of any medications you’re taking while TTC. Some medications prescribed for people with autoimmune conditions aren’t safe for pregnancy. And some may need to be out of your system for a certain amount of time in order to improve fertility outcomes.
Tip 7: Consider fertility preservation.
Men who may need to take gonadotoxic medications (like cyclophosphamide) should talk to their doctor about sperm banking. This is important to think through before treating their autoimmune disorder. This is because these medications could cause irreversible damage to sperm.
Whether you’ve already been diagnosed with an autoimmune disease or you think you may have one, you’re not alone. Many people around the world suffer from autoimmune conditions. And many of them are able to successfully conceive.
So if you’re feeling stressed out, take some relief in knowing that with the right support, there’s hope. If you want to connect with others who are committed to their health and well-being while TTC, consider joining Inito’s TTC Support Group!
FAQs
Yes, for many folks living with an autoimmune disease, it is possible to conceive! However, fertility and pregnancy outcomes depend on the specific autoimmune condition, disease activity, organ involvement, and medications. So if you have a condition and you want to conceive, it’s important to talk to your healthcare team about your fertility goals.
Most autoimmune diseases don’t directly cause infertility. But the symptoms and medications with some conditions can lead to fertility issues. Some of these conditions include :
- Systemic Lupus Erythematosus (SLE, aka lupus)
- Autoimmune thyroid disease (Hashimoto’s thyroiditis and Graves’s disease)
- Rheumatoid arthritis
- Celiac disease
- Behcet’s disease
- Antiphospholipid syndrome (APS)
What’s considered the top 5 worst autoimmune diseases varies, depending on the disease severity for the individual.
Here are some autoimmune diseases that could be considered the most debilitating:
- Systemic lupus erythematosus (SLE)
- Multiple sclerosis (MS)
- Giant cell myocarditis (rare)
- Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis)
- Scleroderma
Deciding to have kids if you have an autoimmune disease is a personal choice. You may face additional risks and hurdles during conception and while raising children. If it’s something you’re considering, talk to a healthcare provider about a specialized treatment plan. This will help you give yourself the best chance at fewer complications!
Two of the hardest autoimmune diseases to diagnose may be lupus and vasculitis. That said, other autoimmune diseases may also be challenging to diagnose due to overlapping symptoms.
Here are 5 common symptoms of an autoimmune disorder to look out for:
- Fatigue
- Chronic pain/inflammation
- Skin issues
- Digestive problems
- Feeling weak or achy
Autoimmune diseases can’t usually be cured or reversed. But many can be controlled with medication and lifestyle changes. The time needed to achieve good disease control varies depending on the condition, disease severity, and individual response to treatment. Some people improve within weeks, while others may take several months.
The top 3 most common autoimmune diseases are:
- Hashimoto’s thyroiditis (hypothyroidism)
- Type 1 diabetes
- Rheumatoid arthritis
Stress isn’t considered a direct cause of autoimmune diseases. However, it may contribute to the development of autoimmune disease in some people who are genetically susceptible. It can also trigger symptom flare-ups in those who already have an autoimmune condition. Autoimmune diseases usually result from a combination of genetic, environmental, and immune system factors.
Most autoimmune diseases don’t have a cure. However, many can be effectively managed with medications and lifestyle measures, allowing people to live healthy, active lives.
Was this article helpful?
- Infertility in women with systemic autoimmune diseases – ScienceDirect
- Recommended Approach for Undiagnosed Autoimmune Diseases, Unexplained Infertility, and Fertility Treatments
- Impact of Systemic Lupus Erythematosus on Conception: Insights into Infertility, Fertility Preservation, Assisted Reproductive Technology, and Pregnancy Outcomes – PMC
- Impact of Systemic Lupus Erythematosus on Conception: Insights into Infertility, Fertility Preservation, Assisted Reproductive Technology, and Pregnancy Outcomes – PMC
- Infertility in women with systemic autoimmune diseases – ScienceDirect
- Behçet’s Disease, Pathogenesis, Clinical Features, and Treatment Approaches: A Comprehensive Review
- The effects of autoimmune rheumatic-related diseases on male reproductive health: A systematic review – PubMed
- Exploring the relationship between Hashimoto’s thyroiditis and male fertility: A meta-analytic and meta-regression perspective on hormonal and seminal factors
- Impact of Systemic Lupus Erythematosus on Conception: Insights into Infertility, Fertility Preservation, Assisted Reproductive Technology, and Pregnancy Outcomes – PMC
