Autoimmune Diseases: – How Do They Affect Fertility?

By (gynecologist), (embryologist) and (babygest staff).
Last Update: 07/05/2019

Autoimmune diseases are those related to the individual's immune system, which is responsible for defending the body from attack by infectious agents, such as viruses and bacteria, among others.

Those who suffer from autoimmune diseases have a malfunctioning immune system and, as a consequence, the immune system reacts in the wrong way by attacking and destroying healthy body cells and tissues.

This situation can also occur during pregnancy, so women with an immune disorder are at increased risk for repeated miscarriages and other fertility disorders.

How does the immune system work?

The body's immune system has the function of recognizing the body's own cells and tissues and distinguishing them from the strange with the aim of constituting defences.

Thanks to this, the organism can defend itself from the attack of harmful external agents, such as pathological microorganisms, radiations, contaminants and even cancer cells.

For its proper functioning, the immune system has a variety of mechanisms such as the following:

  • Recognition of the body's own structures thanks to the major histocompatibility complex (MHC).
  • Production of antibodies by white blood cells or lymphocytes.
  • Destruction of foreign bodies by Natural Killer cells.
  • Establish a mechanism of tolerance during pregnancy so that the mother's immune system does not identify the baby as a foreign body and reject it.

Autoimmune diseases

Autoimmune diseases are those that cause the body's immune system to fail and, as a result, begin to attack the body's own cells and organs. It could be said that the organism attacks itself.

Currently, more than 80 autoimmune diseases are known in humans and are, moreover, we know that they are more common in women than in men.

Depending on the organ or system of the body affected, autoimmune diseases can be classified as follows:

One target
these are specific pathologies of an organ, i.e. they only affect a specific organ. For example, celiac disease is a type of autoimmune disease that affects the small intestine.
Systemic
these diseases can affect any organ, or affect multiple organs or systems at once. In this group we find lupus erythematosus and rheumatoid arthritis.

Why do they occur?

The cause of autoimmune diseases is unknown, we don’t know why the body sometimes attacks itself. However, it is known that there are certain factors that can influence the development of one of these diseases.

There is a genetic predisposition for the development of autoimmune diseases. These diseases are not genetic, they are not inherited, but there are combinations of genes that produce an increased risk of developing an autoimmune disease. Depending on the genes that are affected, there will be a predisposition towards one or the other disease.

In addition, environmental factors can also play a role, since they are necessary to trigger the activation of the immune system. These include hormonal changes, tobacco, alcohol, vaccines, infections, nutrition, eating disorders, weather, etc.

Finally, there are some autoimmune diseases that are more common in some races and ethnic groups. For example, type 1 diabetes is more common among white people, while lupus is more severe in African Americans and Hispanics.

What are the Symptoms?

The manifestation will depend on the type of disease and the organs that are affected, although there may be variations even in cases with the same disease.

The characteristic symptom of an autoimmune disease is inflammation, which causes redness, pain, swelling and warming of the affected area.

Other common symptoms that often appear are discomfort, fever, and fatigue.

Diagnosis

Because the clinical pictures are so varied, it is difficult to diagnose an autoimmune disease.

First, it is necessary to examine the patient's medical history, know his or her family history and detect symptoms that may be associated with an immune pathology.

Next, the medical specialist will need to order a series of clinical studies, such as a blood test to identify markers of inflammation and autoantibodies.

Autoantibodies are antibodies produced by the body against itself, while inflammatory markers are those molecules that are usually present in inflammation processes and can therefore be used to predict the risk of autoimmune disease.

Types of autoimmune diseases

Autoimmune diseases are often chronic diseases that affect the quality of life of people with them.

Below we will briefly describe the most relevant autoimmune diseases, especially those that affect women in their quest to become mothers.

Systemic lupus erythematosus (SLE)

This is a systemic autoimmune disease that can damage various parts of the body, such as joints, skin, kidneys, heart, lungs, and so on.

The clinical manifestations of lupus are very varied, but we can highlight tiredness, weight loss, fever, arthritis, muscle pain, skin lesions, etc..

In the most severe cases, SLE can greatly affect the vital organs of the body, compromising the life of the person.

Multiple sclerosis (MS)

Multiple sclerosis is a chronic neurological disease in which the individual's immune system attacks the protective layer surrounding the nerves.

For this reason, the brain and spinal cord are affected and, as a consequence, multiple sclerosis sufferers have sensory and motor disorders in the extremities.

Other symptoms of multiple sclerosis are optic neuritis, diplopia, ataxia, neurogenic bladder, fatigue, vertigo, etc.

Antiphospholipid syndrome (APS)

This is a type of acquired thrombophilia in which blood clots originate in the arteries and/or veins, which implies a high risk of suffering a thrombosis and a cardiovascular accident.

In addition, APS is known to lead to various complications during pregnancy, such as pre-eclampsia, intrauterine growth restriction, intrauterine fetal death, premature delivery, etc.

The APS is responsible for approximately 15% of recurrent miscarriage. Among the most important antiphospholipid antibodies are the lupus anticoagulant, anti-cardiolipin antibodies and beta2-glycoprotein1.

Type 1 Diabetes mellitus (DM1)

DM1 is a autoimmune disease in which the individual's immune system attacks the insulin-producing cells in the pancreas.

Insulin is a hormone that regulates blood sugar levels. For this reason, people with diabetes mellitus do not produce insulin and have an excessive concentration of sugar in their blood, which can cause damage to many organs, such as the eyes, kidneys, nerves, heart, gums and teeth.

Treatment

Autoimmune diseases cannot be completely cured, as they are chronic and must be treated throughout life so that the affected person can have a better quality of life.

However, there are some treatments aimed at achieving the following goals:

  • Reduce symptoms, such as pain, swelling, trouble sleeping, tiredness, rashes, etc. Analgesics will usually be used, but more complicated interventions such as surgery may be necessary.
  • Replace vital substances that the body cannot produce. This would be the case for people with diabetes who need to inject insulin on a daily basis.
  • Suppress the immune system. These are the known immunosuppressive drugs that reduce the immune response to make sure that vital organs can continue to function. They are given in diseases such as lupus or arthritis.

Some of the drugs most used in autoimmune diseases are corticosteroids such as prednisone and non-steroidal drugs such as cyclophosphamide.

In autoimmune diseases specific to an organ, treatments adapted to the affected organ are carried out.

Autoimmune diseases and pregnancy

Women with autoimmune diseases such as lupus or rheumatoid arthritis may have difficulty having children.

Although these women do not have infertility and can achieve a pregnancy without problems, it could be considered a risky situation because it endangers their life and that of the future baby.

Doctors may contraindicate pregnancy to these women for medical reasons, so their only chance of becoming mothers would be the adoption or surrogacy.

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In contrast, other autoimmune diseases do not affect fertility or the posibility to gestate. For example, multiple sclerosis may subside during pregnancy, although there may also be an increase in outbreaks after childbirth due to the disappearance of the protective effect of gestation on this disease.

FAQs from users

What are the different types of immune infertility?

By Dr. Joel G. Brasch (gynecologist).

The autoimmune diseases that decrease fertility include diabetes, autoimmune thyroiditis and systemic lupus erythematosus. Other causes of infertility such as premature ovarian insufficiency, endometriosis and polycystic ovarian syndrome include autoimmune components.

How do immune infertility treatments work?

By Zaira Salvador (embryologist).

This depends in the first place on the type of immunological infertility, that is to say, on the concrete cause that prevents the pregnancy. For example, when there are blood clotting problems and the risk of thrombosis, a treatment with heparin can help a woman achieve an evolutionary pregnancy.

On the other hand, treatment with corticoids and immunoglobulins may also be indicated in cases of immunological infertility.

What are the causes of embryo immune rejection?

By Zaira Salvador (embryologist).

Pregnancy is a special condition in which the woman's immune system must activate a tolerance mechanism so as not to reject the baby's body during the entire gestation period. To do this, the embryo expresses the HLA G antigen, whose function is to suppress the cells of the mother's immune system and that there is no rejection.

However, there are cases in which there is a failure in the mechanism of tolerance, so that the mother's immune system does not recognize the embryo as its own and, therefore, rejects it causing an abortion. This usually occurs in women who have a high number of Natural Killer (NK) cells, immune system cells that destroy embryonic tissues by not recognizing them.

Are autoimmune diseases curable?

By Zaira Salvador (embryologist).

Autoimmune diseases have no cure, they are chronic, since it is not known where exactly the problem lies.

However, there are treatments to improve the quality of life of the people who suffer them and that their lives are not endangered.

Suggested for you

One of the biggest problems for women with reproductive desire who suffer from autoimmune diseases is the risk of recurrent miscarriages, which causes enormous physical and emotional strain. If this is your situation and you want to learn more, you can continue reading here: What is recurrent miscarriage? – Reasons, Tests and Treatment.

On the other hand, if you need information about other diseases that also prevent or contraindicate pregnancy, you can access the next post: Medical Contraindications to Pregnancy – When to Use a Surrogate.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Alijotas-Reig J, Esteve-Valverde E. Pregnancy and autoimmune diseases. Med Clin (Barc). 2017 Feb 23;148(4):161-163.

Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2017 Jun;31(3):397-414.

Panaitescu AM, Nicolaides K. Maternal autoimmune disorders and fetal defects. J Matern Fetal Neonatal Med. 2018 Jul;31(13):1798-1806.

Wang L, Wang FS, Gershwin ME. Human autoimmune diseases: a comprehensive update. J Intern Med. 2015 Oct;278(4):369-95.

FAQs from users: 'What are the different types of immune infertility?', 'How do immune infertility treatments work?', 'What are the causes of embryo immune rejection?' and 'Are autoimmune diseases curable?'.

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Authors and contributors

Dr. Joel G. Brasch
Dr. Joel G. Brasch
Gynecologist
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Zaira Salvador
Zaira Salvador
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia (UPV). Embryologist specializing in Assisted Procreation, with a Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI). More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

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