Autoimmune Disease and Fertility: What Patients Should Know

In short: Autoimmune diseases occur when the immune system attacks the body’s own healthy tissue. They can affect ovulation, ovarian function and implantation, and raise the risk of recurrent miscarriage. Those most linked to fertility are autoimmune thyroid disease, lupus, antiphospholipid syndrome and rheumatoid arthritis. Treatment depends on the condition and may include immune-modifying drugs, prednisolone, progesterone, aspirin and blood thinners.

Autoimmune disease occurs when the body’s immune system mistakenly attacks its own healthy tissues. If you or a loved one are dealing with fertility challenges, it helps to understand that this condition might affect fertility in both men and women, and knowing more about it can make the journey feel less overwhelming.

How does autoimmune disease affect fertility?

• In a healthy pregnancy the body must accept the embryo and support its growth.
• In autoimmune disease, an abnormal immune response may interfere with ovulation, implantation, embryo development, or pregnancy maintenance.

Some autoimmune conditions may:

• Affect ovarian function
• Affect egg quality
• Increase inflammation in the reproductive organs
• Interfere with embryo implantation
• Raise the risk of recurrent miscarriage
• Affect hormonal balance
• Affect menstrual cycles

Thyroid autoimmune disorders:

• Hashimoto thyroiditis and Graves’ disease

Systemic lupus erythematosus:

Affects fertility through:

• Inflammation
• Medication
• Complications related to pregnancy

Antiphospholipid syndrome:

Leads to:

• Recurrent pregnancy loss
• Implantation failure
• Abnormal blood clotting

Rheumatoid arthritis:

• Chronic inflammation
• Some harmful medications

Endometriosis:

• Has an autoimmune component
• Leads to chronic inflammation which affects fertility

IVF challenges related to autoimmune disease:

• Inflammation-related problems with implantation

When to suspect autoimmune disease as a cause of pregnancy complication or infertility:

• Recurrent miscarriage
• Unexplained infertility
• Associated systemic manifestations

Evaluation of autoimmune disease may include:

• Thyroid function tests
• Autoimmune antibody screen
• Hormonal tests
• Ultrasound examinations
• Antiphospholipid antibody tests (a wider thrombophilia screen only if there is a personal or family history of blood clots)

Medications that may be considered when autoimmunity is suspected to be a cause of infertility:

Immune modulating medications such as:

• Prednisolone (for treating a diagnosed autoimmune disease such as lupus; its routine use to improve implantation is not supported by current evidence)
• Progesterone supplements
• Vitamins and antioxidants
• Intralipid (still experimental; current guidelines recommend using it only within research studies)
• Aspirin and heparin injections, which are proven to help women with antiphospholipid syndrome, but are not recommended routinely for other women

It is important to know that, apart from treating a confirmed autoimmune disease (such as antiphospholipid syndrome, thyroid disease or lupus), immune treatments for infertility or failed IVF are still under research, and international guidelines do not recommend them routinely; your doctor will discuss whether any of them is suitable in your particular case.

With proper medical care, many patients with autoimmune disease are able to conceive and deliver healthy babies. Care in these cases works best when it is multidisciplinary, bringing together fertility, immunology, and obstetric expertise. If you have an autoimmune condition and are concerned about your fertility or planning a pregnancy, Dr. Najeeb Layyous and his team can help guide you through the right evaluation and personalized care plan.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist