Autoimmune diseases: how do they affect fertility and pregnancy?

By BSc, MSc (embryologist), BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and BSc, MSc (psychologist).
Last Update: 12/17/2021

An autoimmune disease is a pathology of the immune system characterized by the attack and destruction of the body's own healthy cells and tissues because the immune system detects it as foreign. Therefore, a person is said to have an autoimmune disease when cells of his or her immune system attack healthy cells in the body.

Although autoimmune diseases can occur at any time in life, they can also occur during pregnancy. One of the main consequences of autoimmune diseases is that it increases the likelihood of recurrent miscarriages, as well as affects fertility. Therefore, it is essential to plan pregnancy correctly in people with autoimmune diseases.

What is an autoimmune disease?

Autoimmune diseases, also known as autoimmune diseases, are those pathologies caused by an error in the immune system autoimmune diseases autoimmune diseases, are those pathologies caused by an error in the immune system. In this way, the body's healthy tissues and cells are recognized as foreign and the immune system itself begins to attack them.

Currently, there are more than 80 different autoimmune diseases. These diseases can be:

  • Local, i.e. affecting a specific organ. An example of a local autoimmune disease would be celiac disease.
  • Systemic, whose damage is caused in the organism in general. For example, multiple sclerosis or lupus are systemic diseases.

In any case, the damage will appear in one place in the body depending on the type of autoimmune disease. In addition, autoimmune diseases are more common in women than in men, although the reason for this is unknown.

Causes

The specific cause that leads to the body attacking itself is not known. However, there are certain risk factors such as genetic predisposition or certain environmental factors that increase the likelihood of developing an autoimmune disease.

In addition, race and ethnicity are also related to autoimmune diseases. For example, lupus is a disease with a higher prevalence among African Americans and Hispanics. In contrast, diabetes is common in white people.

However, most systemic autoimmune diseases affect women and, on numerous occasions, arise during the childbearing or reproductive years. For this reason, it is important to know the effect of autoimmune disease on pregnancy and vice versa.

Most common autoimmune diseases

As mentioned above, the function of the immune system is to protect the body against disease and infection. However, any error in this system causes a problem.

The following are some of the most common autoimmune diseases in the population.

Systemic lupus erythematosus

It is an autoimmune inflammatory disease that causes damage to the body in general, i.e. it is a systemic disease. The symptoms caused by this pathology may vary from one person to another, although fatigue, fever, arthritis, photosensitivity, skin lesions, etc. are most common.

Lupus usually occurs in women of childbearing age. In addition, one of the consequences associated with the treatment applied for this disease is that the ovarian reservemay decrease. For this reason, women diagnosed with lupus may have problems achieving pregnancy.

Multiple sclerosis

Multiple sclerosis (MS) is also an autoimmune disease, although its effect is at the neurological level. It is a neuroimmunological disease, as the immune system's own cells attack the myelin sheaths surrounding the nerves.

The function of myelin sheaths is to transmit the nerve impulse quickly and efficiently. Any damage or destruction of the myelin sheaths causes them to be unable to exert their activity so that the transmission of the nerve impulse will be slow.

Some clinical manifestations associated with MS are:

  • Optic neuritis.
  • Ataxia, i.e., decreased coordination.
  • Neurological bladder.
  • Fatigue.
  • Numbness and tingling.

Antiphospholipid syndrome

This disease is also known as hughes syndrome and is characterized by the presence of thrombosis. In addition, pregnant women with FAS are at increased risk of suffering:

  • Spontaneous abortions
  • Preterm deliveries.
  • Preemclampsia.
  • Delayed intrauterine growth.

Therefore, it is essential to plan pregnancy in women diagnosed with this syndrome to avoid complications.

Diabetes Mellitus type I

It is an autoimmune disease caused by the attack of pancreatic cells. These cells are responsible for producing insulin, a hormone that is essential for regulating blood levels in the body. Therefore, the most characteristic symptom of diabetes is the presence of high blood sugar concentrations.

As a consequence of this excess of sugar in the organism, damage to the eyes, kidneys, nerves, etc. may occur.

Myasthenia Gravis

This disease is classified as a neuromuscular autoimmune disease, as the individual's own cells attack the neuromuscular junctions of the voluntarily contracting muscles.

The most frequent clinical manifestations in people with myasthenia gravis are weakness and fatigue in any muscle of the body. In addition, this disease is associated with drooping eyelids and double vision.

Nevertheless, myasthenia gravis is not a symmetrical pathology. This means that muscle weakness is different on each side of the body.

Hashimoto's thyroiditis

Hashimoto's disease is a condition caused by the body's cells attacking the thyroid gland. In many cases, Hashimoto's thyroiditis causes a decrease in the function of the gland, resulting in hypothyroidism. The clinical picture of Hashimoto's thyroiditis includes:

  • Constipation.
  • Dry skin.
  • Goiter.
  • Weight gain.
  • Fatigue.
  • Alteration of menstruation.

However, these symptoms are not the only ones that can arise in people with Hashimoto's thyroiditis. For example, tiredness, intolerance to cold, or decreased organ activity are also signs of this disease.

Problems during pregnancy

Most autoimmune diseases have a strong hormonal influence. Since pregnancy involves a series of strong hormonal changes, it seems logical to think that the coexistence of both (autoimmune disease and pregnancy) can lead to complications.

However, for some of these diseases, such as multiple sclerosis, pregnancy is usually a relief. This is not always the case, as there are also cases in which gestation aggravates the disease.

The hormonal status of pregnancy may cause the disease to remit or lessen the harmful consequences. However, this "protective effect" disappears after childbirth and may even reactivate the disease in a more intense form, leading to frequent relapses and outbreaks. For this reason, women suffering from autoimmune diseases should consult their physician before attempting pregnancy to avoid endangering their health and that of the future baby.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

On the other hand, and to avoid this aggravation of the disease after childbirth, it is important to start immunomodulatory treatment immediately. For this reason, breastfeeding is strongly discouraged in these cases, since the medication taken could pass into the breast milk and affect the baby.

Treatment of autoimmune diseases

In addition to possible problems that may arise during pregnancy and after childbirth due to the autoimmune disease, complications related to the medication prescribed for the disease may also occur.

For example, immunosuppressive treatment of SLE based on cyclophosphamide and methotrexate may have teratogenic effects. Therefore, pregnancy is strongly discouraged if a woman is given this treatment for SLE. Another common drug in cases of SLE with nephropathy is azathioprine, the administration of which has been associated with intrauterine growth retardation and prematurity.

In addition, corticosteroids such as prednisone are also common among people with autoimmune diseases. This medication is usually prescribed especially during flare-ups or crisis periods. The administration of corticosteroids is also not indicated during pregnancy.

Although there are several pharmacological treatments that help to improve the patient's quality of life, there is no cure for autoimmune diseases.

FAQs from users

Is natural pregnancy or assisted reproduction pregnancy better in MS patients?

By Dra. Rut Gómez de Segura MD (gynecologist).

Multiple sclerosis does not cause infertility or prevent pregnancy naturally. Therefore, we would advise resorting to assisted reproduction treatment after 6 months to a year of natural attempts. In the case of fertility treatment, it would be advisable to study the patient's immunology and all the parameters of ovarian reserve and general health of the couple.

Also, we would have to work together with the patient's physician to make sure that pregnancy and childbearing do not pose any risk to the patient and the future baby.

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is an autoimmune disease, which means that the patient's own immune system attacks the body.

Is there a cure for autoimmune diseases?

By Marta Barranquero Gómez BSc, MSc (embryologist).

No. All autoimmune diseases are chronic, that is, they last a lifetime. Treatments for autoimmune diseases do not cure the condition, but help to improve the patient's quality of life.

In addition, these treatments also serve to prevent possible flare-ups or relapses of the disease.

Does autoimmune thyroiditis cause infertility?

By Zaira Salvador BSc, MSc (embryologist).

Yes, autoimmune thyroiditis, also known as Hashimoto's disease, is the most common cause of hypothyroidism. The woman's body makes antibodies that attack the thyroid gland. As a result, a decrease in the amount of thyroid hormones occurs, causing irregularities in the menstrual cycle, among others.

You may also enjoy some further information reading this: Impact of Thyroid Hormones on Female Fertility.

What autoimmune diseases affect pregnancy?

By Marta Barranquero Gómez BSc, MSc (embryologist).

Most autoimmune diseases can affect in pregnancy due to hormonal influence. Pregnancy involves a number of hormonal changes in a woman's body, which can alter the immune condition.

However, in the case of multiple sclerosis or other types of autoimmune diseases, pregnancy is a protective situation for the woman. This is not always the case, as there are also cases in which pregnancy aggravates the autoimmune disease.

In any case, the protective effect of pregnancy for patients with immune pathologies disappears after delivery. In addition, it is important to start medication as soon as possible, as the disease could be reactivated more intensely.

What are the risk factors for autoimmune diseases?

By Marta Barranquero Gómez BSc, MSc (embryologist).

Autoimmune diseases are chronic conditions, i.e. they are present throughout an individual's life, although the reason for their occurrence is unknown.

However, autoimmune diseases are related to genetic predisposition and environmental factors. Thus, some of the risk factors for this type of pathology are tobacco consumption, sun exposure, virus infections, stressful situations, etc. However, the presence of these factors is not an indication that an autoimmune disease will develop.

In addition, some of these factors can also affect the evolution of the disease causing a greater tendency to suffer an outbreak.

One of the risks associated with autoimmune diseases in pregnancy is recurrent miscarriage. If you wish to continue reading information about this topic, you can visit this link: Miscarriage: symptoms, causes, and consequences.

However, autoimmune diseases are not the only ones that can influence pregnancy. For information on all diseases, we advise you to read the following article: Illnesses in pregnancy: risks to mother and baby.

We make a great effort to provide you with the highest quality information.

🙏 Please share this article if you liked it. 💜💜 You help us continue!

References

Alijotas-Reig J, Esteve-Valverde E. Pregnancy and autoimmune diseases. Med Clin (Barc). 2017 Feb 23;148(4):161-163. Best Pract Res Clin Obstet Gynaecol. 2019 Oct;60:66-76. doi: 10.1016/j.bpobgyn.2019.03.003

De Carolis S, Moresi S, Rizzo F, Monteleone G, Tabacco S, Salvi S, Garufi C, Lanzone A. Autoimmunity in obstetrics and autoimmune diseases in pregnancy

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

Jara L, Cruz-Dominguez MP, Saavedra M. Impact of infections in autoimmune rheumatic diseases and pregnancy. Curr Opin Rheumatol. 2019 Sep;31(5):546-552. doi: 10.1097/BOR.0000000000000636.

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

Somers E. Pregnancy and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:3-10. doi: 10.1016/j.bpobgyn.2019.11.004.

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

FAQs from users: 'Is natural pregnancy or assisted reproduction pregnancy better in MS patients?', 'Is there a cure for autoimmune diseases?', 'Does autoimmune thyroiditis cause infertility?', 'What autoimmune diseases affect pregnancy?' and 'What are the risk factors for autoimmune diseases?'.

Read more

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
 Marta Barranquero Gómez
Marta Barranquero Gómez
BSc, MSc
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Dra. Rut Gómez de Segura
Dra. Rut Gómez de Segura
MD
Gynecologist
Graduation in Medicine and Surgery from the University of Alcalá de Henares. Specialization in Obstetrics and Gynecology at the Hospital Costa del Sol in Marbella. Dr Rut Gómez de Segura currently works as medical director in the fertility center ProcreaTec in Madrid. More information about Dra. Rut Gómez de Segura
Licence number: 28/2908776
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human 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:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
BSc, MSc
Psychologist
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman
Member number: CV16874

Find the latest news on assisted reproduction in our channels.