What is systemic lupus erythematosus and how does it affect fertility?

By (gynecologist), (embryologist) and (embryologist).
Last Update: 07/03/2024

Systemic lupus erythematosus(SLE or Lupus) is a chronic autoimmune disease affecting connective tissue. This disease is characterized by inflammation and tissue damage mediated by the immune system, specifically due to the binding of antibodies to the body's cells and the deposition of antigen-antibody complexes.

SLE can affect any part of the body, although the most common sites are the reproductive system, joints, skin, lungs, blood vessels, kidneys, liver (the first organ it usually attacks) and the nervous system. The course of the disease is unpredictable, with periods of crisis alternating with remission.

However, the fertility of people with lupus erythematosus is not affected, although the search for pregnancy must be planned.

What is lupus erythematosus or SLE?

Lupus erythematosus, also known by its acronym SLE, is an autoimmune disease in which the patient's own body attacks its organs and tissues. It is a systemic disease since it can affect any area of the body. In addition, lupus erythematosus has no cure, but there are different treatments to control the disease.

The most specific symptom of lupus is the presence of a butterfly-shaped erythema on the face, although it is not the only one. Other signs of SLE include the following:

  • Joint pain or swelling.
  • Fever without apparent cause.
  • Chest pain.
  • Pale or purple feet.
  • Extreme fatigue.
  • Photosensitivity.
  • Anemia

The incidence of this disease is much higher in women than in men, but this does not mean that men do not suffer from systemic lupus erythematosus.

What are the causes of lupus?

The exact cause of lupus erythematosus is unknown. However, there is scientific evidence that lupus may be due to a combination of genetic and environmental factors.

What is clear is that lupus is not a disease that is transmitted to offspring or contagious. However, there seems to be a genetic predisposition which, in combination with certain factors, could be the reason for developing the disease.

Triggers for lupus erythematosus include:

  • Hormonal changes.
  • Viral infections.
  • Family history of autoimmune diseases such as multiple sclerosis or rheumatoid arthritis, for example.
  • Physical and emotional stress.
  • Ultraviolet light from solar radiation.

Apart from all these triggers, it is also possible to develop a benign form of lupus erythematosus induced by the administration of certain medications. This is the case of the consumption of antipsychotics such as cabamazepine, antibiotics such as minocycline, diuretics such as hydrochlorothiazide, etc.

Lupus erythematosus treatment

As mentioned above, there is no cure for SLE, but several treatments are available to control its progression. This disease causes outbreaks, so the purpose of pharmacological treatment is to prevent them from occurring. Each type of drug and its action is detailed below:

  • Anti-inflammatory drugs : help reduce joint pain
  • Antimalarials: reduce rashes and skin conditions. In addition, these drugs control extreme tiredness and fever.
  • Corticosteroids: these are the most important drugs in the treatment of lupus erythematosus, since they deactivate lupus when there is a flare.
  • Immunosuppressants: they are usually indicated when there are renal complications.

Other considerations for treating systemic lupus erythematosus include avoiding exposure to ultraviolet rays through sun protection. In addition, most specialists advise SLE patients to be vaccinated against influenza and pneumococcus.

Does lupus affect fertility?

Lupus itself does not interfere with a woman's fertility, although it may make it difficult to carry a pregnancy to term. Assessment of disease status before a woman becomes pregnant is essential. In addition, it should also be known that there is an increased risk of suffering an outbreak of the disease after giving birth.

Nevertheless, the fact is that lupus treatment may affect a woman's ovarian reserve. This would explain the difficulty in achieving pregnancy in women diagnosed with lupus erythematosus.

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.

In those cases in which pregnancy does not occur naturally, there is the possibility of resorting to assisted reproductive techniques. This is possible as long as the disease is controlled, as ovarian stimulation could lead to a flare-up. However, this situation would be easily resolved with treatment.

Pregnancy with lupus

Years ago, systemic lupus erythematosus (SLE) and pregnancy were irreconcilable enemies. Fortunately, several factors have resulted in many women with SLE now becoming pregnant and giving birth to children.

Pregnancy in SLE patients should be planned. This would avoid the situation of a patient with lupus becoming pregnant at a time when the disease situation does not make it advisable or the treatment of the disease contraindicates it.

For many years the use of oral contraceptives was prohibited in women with SLE. However, today the scientific literature says that this contraindication exists only in a selected group of women with SLE.

In either case, systemic lupus erythematosus increases the risk that the pregnant woman will suffer:

  • Arterial hypertension or preeclampsia.
  • Spontaneous abortion.
  • Premature delivery.
  • Having a low birth weight baby.
  • Hemorrhage after childbirth.
  • Thrombosis.

In addition, babies born to mothers with lupus erythematosus are more likely to have lupus nenonatorum, although it will disappear with time and 90% of cases do not develop the disease in the future.

Importance of medical control

When a patient with SLE expresses her desire for pregnancy, several very important points should be taken into account:

  • Lupus activity at that time.
  • Treatment.
  • Serological characteristics (positivity for certain autoantibodies), etc.

For example, a woman with active renal involvement or on cyclophosphamide treatment should postpone her pregnancy to a more favorable time when the nephritis is persistently under control and the use of drugs that are absolutely contraindicated during pregnancy is not required.

A monographic consultation in which close monitoring of these patients is carried out is one of the factors involved in improving the prognosis of pregnancies in patients with SLE.

FAQs from users

Does lupus erythematosus cause infertility?

By Ana Mª Villaquirán Villalba M.D., M.Sc. (gynecologist).

Infertility as an aspect of reproductive health related to systemic lupus erythematosus (SLE) is understudied, but is of increasing interest as assisted reproductive technology (ART) methods become increasingly sophisticated and more widely available. However, the question of whether SLE inherently affects fertility remains unanswered.

Is there danger in pregnancy in women with lupus?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

If the disease is controlled at the time of pregnancy, there should be no consequences. However, it is essential that women diagnosed with lupus plan their pregnancy in advance to avoid endangering their health.

Is lupus erythematosus hereditary?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Lupus is not an inherited disease, although there seems to be an inherited predisposition to contract the disease. Thus, people predisposed to the disease may develop lupus if they come into contact with certain risk factors.

However, lupus erythematosus is not necessarily transmitted from parent to child.

Is breastfeeding possible in women with lupus?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

In principle, breastfeeding is possible in women with systemic lupus erythematosus. However, it is important to discuss the desire to breastfeed with the physician since certain drugs may be transferred through the milk to the baby.

Suggested for you

Systemic lupus erythematosus is a possible cause of immunologic sterility. If you wish to continue reading information on this subject, we recommend you to visit this article: Immunological infertility: types, causes and treatments.

If, on the other hand, you would like more information about other autoimmune diseases and their effect on pregnancy, then we recommend this article: Autoimmune diseases: how do they affect fertility and pregnancy?

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FAQs from users: 'Does lupus erythematosus cause infertility?', 'Is there danger in pregnancy in women with lupus?', 'Is lupus erythematosus hereditary?' and 'Is breastfeeding possible in women with lupus?'.

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Authors and contributors

 Ana Mª Villaquirán Villalba
Ana Mª Villaquirán Villalba
M.D., M.Sc.
Bachelor's Degree in Medicine from the University of Valle, Colombia. Specialist in Obstetrics & Gynecology. Master's Degree in Human Reproduction from the University of Valencia and IVI. Currently, she is the medical director of Tahe Fertilidad. More information about Ana Mª Villaquirán Villalba
License: 303007571
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
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
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV

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