Fertility and autoimmune diseases: what you need to know before starting treatment

If you have an autoimmune disease and are also experiencing difficulties in becoming a mother, it is completely normal to have a lot of questions. Will I be able to get pregnant? How will my condition affect fertility treatment? The truth is that the connection between fertility and autoimmune diseases is complex, but not insurmountable. The most important thing is to develop a personalised strategy tailored to each individual situation. Below, you will find everything you need to know before starting fertility treatment when you also have an autoimmune disease.

The relationship between the immune system and fertility

The immune system is designed to protect us from external agents such as viruses and bacteria. However, in autoimmune diseases, this system mistakenly attacks the body’s own healthy cells and tissues.

If this abnormal response occurs, for example, during pregnancy, it may affect it and even lead to its interruption. This is why one of the main consequences of autoimmune diseases is an increased likelihood of recurrent miscarriage.

Some autoimmune diseases, such as SLE (Systemic Lupus Erythematosus), may be associated with a higher risk of POI (premature ovarian insufficiency), either directly or as a consequence of treatment. POI can reduce the chances of becoming a mother, a problem that is further aggravated when, for medical reasons, motherhood needs to be delayed.

Certain immunological alterations may influence embryo implantation, as well as the normal development of the placenta. For this reason, the risk of implantation failure, recurrent miscarriage, as well as pre-eclampsia or preterm birth, tends to increase in women with certain autoimmune diseases. However, the magnitude of this risk largely depends on the disease itself, its level of activity and the treatment involved.

Autoimmune diseases that may affect fertility

There are many autoimmune diseases, but those with the greatest demonstrated impact on fertility and pregnancy are:

Systemic lupus erythematosus (SLE)

Lupus is a chronic autoimmune disease in which the immune system attacks healthy tissues and organs, such as the skin, joints, kidneys, brain and other internal organs. Its severity varies greatly between individuals. It can cause widespread inflammation and damage to multiple body systems, also affecting reproductive capacity and increasing the risk of complications during pregnancy.

Ovarian reserve may be affected both by the disease itself, due to the deposition of immune complexes in ovarian tissue and alterations in the reproductive hormonal axis, as well as by certain treatments used to control it.

It is important to note that many patients with lupus may also have antiphospholipid syndrome, which significantly increases the risk of obstetric complications. For this reason, screening for antiphospholipid antibodies forms part of the reproductive assessment of these patients.

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Antiphospholipid syndrome (APS)

APS is an autoimmune disorder characterised by the production of antibodies that attack phospholipids, essential components of cell membranes. This leads to an increased risk of blood clot formation (thrombosis) in veins and arteries. In the context of fertility, APS can cause recurrent miscarriage, pre-eclampsia and other pregnancy complications.

It is one of the autoimmune causes of recurrent miscarriage for which effective treatment is available, and it may also lead to pre-eclampsia, fetal growth restriction and other gestational complications. Diagnosis requires laboratory confirmation of these antibodies, together with the corresponding clinical criteria.

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Hashimoto’s thyroiditis

This is a condition in which the immune system attacks the thyroid gland, reducing its ability to produce thyroid hormones and leading to hypothyroidism.Thyroid hormones play an important role in regulating the menstrual cycle and ovulation. Although its direct relationship with embryo implantation is less clear, thyroid autoimmunity has been associated with a higher risk of miscarriage, even in women with apparently normal hormone levels. This suggests that, beyond hormonal function, the immune dysfunction itself may play a role in adverse pregnancy outcomes, which is why proper diagnosis and thyroid control are very important in the context of fertility.

Alterations in these hormone levels may also increase the risk of abnormalities in the development of the fetal nervous system. However, with adequate hormonal control, this risk is significantly reduced.

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Multiple sclerosis (MS)

Multiple sclerosis is a chronic inflammatory autoimmune disease of the central nervous system. It causes damage to myelin, the protective layer surrounding nerve fibres, which may lead over time to progressive neuronal damage. This impairs the transmission of nerve impulses from the brain, resulting in various symptoms depending on the affected area of the nervous system: muscle weakness, loss of mobility, sensory disturbances such as paraesthesia (tingling), loss of visual acuity, among others.

This disease does not cause infertility nor prevent pregnancy, but it may increase the likelihood of delaying motherhood. In addition, certain symptoms associated with the disease, such as fatigue, as well as some pharmacological treatments, may influence reproductive capacity. It is also important to understand that pregnancy in women with MS requires careful planning, as there is a higher risk of disease flare-ups after childbirth.

As for assisted reproduction techniques, they are not contraindicated in these patients, but it is essential to ensure that treatment is carried out during a stable phase of the disease.

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Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disorder in which the immune system attacks the joints, causing inflammation, pain and loss of joint function. Although its direct effect on fertility is lower than in other conditions, chronic inflammation, physical impact and some immunosuppressive treatments may affect ovarian reserve, the menstrual cycle and the overall wellbeing required for pregnancy.

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Type 1 diabetes mellitus (T1DM)

Unlike other types of diabetes, type 1 diabetes mellitus is a condition in which the insulin-producing cells in the pancreas are destroyed. Without insulin, glucose accumulates in the bloodstream, leading to various systemic complications.

In men, poor control of T1DM may reduce semen quality and increase the risk of retrograde ejaculation, resulting in male infertility. In women, in addition to causing ovulatory disorders, poor control of T1DM may increase the risk of pregnancy complications such as pre-eclampsia, congenital malformations and other serious conditions.

Strategies to improve the chances of pregnancy

In cases of infertility, assisted reproduction treatments for women with autoimmune diseases are safe.

However, since autoimmune diseases play an important role in embryo quality and the uterine environment, thelikelihood of recurrent IVF failure can be reduced by addressing these conditions before treatment.

At Tambre, we understand the important interaction between fertility and autoimmune diseases, which is why it is necessary to implement a series of strategies:

• To improve the chances of success and reduce risks, it is essential that the autoimmune disease is well controlled before starting assisted reproduction treatment. The required period of stability varies depending on the condition, but is generally around six months, although this should be adapted to each case.
• It is necessary to evaluate the medical history and the current status of the disease.
• We carefully plan each fertility treatment in a personalised way, adapting it to each situation in order to minimise risks and optimise outcomes.
• Lifestyle factors can influence immune response during IVF. A healthy diet, regular exercise and stress management can contribute to the proper functioning of the immune system. In addition, avoiding toxins and maintaining a healthy body weight may help improve the chances of achieving positive IVF outcomes.
• Embryo selection. Once egg retrieval and fertilisation have been carried out, at Tambre we use advanced technologies to screen embryos for genetic abnormalities. Thanks to Preimplantation Genetic Testing (PGT), we can detect potential genetic and/or chromosomal disorders in embryos, improving the chances of success in an IVF cycle and preventing the transfer of chromosomally abnormal embryos.
• Specialised monitoring. At Tambre, we carry out continuous monitoring, allowing us to adapt the protocol according to each patient’s progress.

Thanks to these strategies and care, we can significantly improve the chances of pregnancy in women with autoimmune diseases. We firmly believe that the knowledge and experience of our teams, together with personalised treatment, are key to successfully addressing the challenges posed by the combination of fertility and autoimmune diseases. If you have an autoimmune disease and wish to become a mother, do not hesitate to contact us on +34 91 411 61 11 to book your first consultation.

Our team of experts will support you every step of the way, designing a personalised plan for you, ensuring strict health monitoring and increasing your chances of achieving the pregnancy you desire.