THE ROLE OF AUTOIMMUNE DISEASES IN INFERTILITY

Having trouble conceiving? Autoimmune diseases are a group of conditions that occur when the body’s immune system malfunctions. These conditions are usually the result of a genetic predisposition which mistakenly turns on itself, triggering inflammatory responses, and destroying healthy cells and tissues. Infertility is defined as the inability to conceive after a 12 month period when no contraception is used. Some autoimmune diseases can contribute towards fertility problems and/or conception difficulties in both sexes or may result in pregnancy loss.

Numerous autoimmune diseases may be associated with primary infertility and pregnancy loss through different mechanisms. Serum auto-antibodies, such as anti-phospholipid, anti-thyroid, or antinuclear antibodies are demonstrated to be directly associated with infertility, regardless of the presence of an autoimmune disorder. A close interplay exists between optimal functioning and adapting endocrine and immune systems, with both systems directly linked to the thyroid gland. Autoimmunity may affect all stages of fertility, via ovarian failure, testicular failure, implantation failure, IVF failure and pregnancy loss.

Infertility may also be secondary to vasculitis associated with other conditions such as systemic lupus erythematosus and diabetes mellitus due to certain antibodies directly damaging the preimplantation embryo, interfering with implantation process or formation of placenta. This results in the overall activation of the immune system in female infertility. Autoimmune thyroid disease is present in 5–20% of pregnant women. When this disease is present, the impact of controlled ovarian hyperstimulation may become more severe.

Changes in SHBG and sex steroids in both male and female are a consistent feature associated with hyper and hypothyroidism. Male reproduction is adversely affected

by both thyrotoxicosis and hypothyroidism, which can result in erectile dysfunction and abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances, as well as being associated with hypomenorrhea and polymenorrhagia. If you are having trouble conceiving, contact us for an appointment to discuss with your doctor.