The relationship between pregnancy and autoimmune disease goes both ways. Having an autoimmune disease significantly influences pregnancy — from before conception to the postpartum period. Likewise, pregnancy can trigger certain autoimmune diseases, exacerbate existing ones, and even put some into temporary remission. Typically, with the proper care and disease management, most women with autoimmune diseases are able to get pregnant. However, there are proven connections between autoimmune diseases and fertility, and certain autoimmune diseases and medications may make it challenging to conceive.
What Is Infertility?
Infertility is the inability to get pregnant. Specifically, your health care provider will diagnose you with infertility if you’ve been trying to conceive (by having unprotected sex) for 1 year without success. Infertility can affect both men and women; of course, both you and your partner will need to be fertile to conceive.
If you’re struggling to get pregnant, you’re not alone. Infertility is a relatively common condition, affecting around 9% of men and 11% of women of reproductive age in the United States. In couples who can’t get pregnant, a third of cases are clearly attributable to the man and a third to the woman, while in the remaining cases either the issue is with both partners or the cause can’t be determined. (Source)
Aside from being infertile, a person may also be subfertile or have impaired fertility, meaning they can get pregnant, but it’s more difficult than it should be. Unlike infertility, subfertility lacks a distinct clinical definition. In their review of research on subfertility, one team of researchers suggested that, to avoid confusion, subfertility could simply be described as any level of reduced fertility. (Source)
What Autoimmune Diseases Can Cause Infertility?
Infertility affects both men and women, and autoimmune diseases can trigger fertility issues in both. In women, infertility (your health care provider may call it reproductive failure) is most commonly associated with abnormalities in ovulation or menstruation. In men, it’s often connected to poor sperm quality or low sperm activity.
Women with rheumatoid arthritis (RA) are less likely to have children than those without the condition. On average, they spend more time trying to conceive and are more likely to undergo fertility treatments. Further, women with RA may have to put their pregnancy plans on hold due to disease status or medications that shouldn’t be taken during pregnancy.
In a study of 178 women with RA who were pregnant or trying to conceive, nearly half of all cases of diagnosed subfertility were unexplained. Another 28% of subfertility issues were linked to anovulation (where the egg fails to release). In participants for whom the cause was unknown, the researchers suggested that subfertility might be related to both disease-related factors and use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Fortunately, according to the same study, fertility treatments are as effective (or more effective) in women with RA compared to other subfertile groups. (Source)
The CDC estimates that the prevalence of infertility among the general population of heterosexual women is around 20%. Research indicates this number is much higher — about 52% — in women with Graves’ disease.
Infertility associated with Graves’ disease may be directly linked to the disease’s characteristic thyroid dysfunction. However, Graves’ disease also causes menstrual irregularities, which can make it challenging to conceive. (Source, Source)
Like Graves’ disease, Hashimoto’s is an autoimmune thyroid disease. In the study mentioned above, researchers found that participants with Hashimoto’s were slightly less likely (47%) to experience infertility than those with Graves’, but still much more likely than the general population.
Women with Hashimoto’s typically have fewer children and struggle with subfertility at a younger age. It’s unclear why, but fertility in women with Hashimoto’s seems to be most affected in the 6 years following diagnosis. More research is needed to draw solid conclusions, but the increased likelihood of subfertility may be connected to a spike in autoimmune processes that lead to thyroid issues in the initial years. Regardless of the “why,” autoimmune thyroid diseases, such as Hashimoto’s, interfere with ovulation, causing fertility issues.
While both Graves’ and Hashimoto’s are more common in women than men, the fertility problems linked to thyroid autoimmunity are not exclusive to women. Men with thyroid diseases are more likely to experience issues with sperm quality and activity than those without it. (Source, Source)
Inflammatory Bowel Disease
There’s no evidence that women with ulcerative colitis are more likely to struggle with infertility than the general population. However, fertility is impaired in women with Crohn’s disease. Infertility linked to Crohn’s disease is related to disease activity; in most cases, it’s not permanent. When they achieve remission, women with Crohn’s disease typically see restored fertility. (Source)
Type I Diabetes
Type I diabetes impairs fertility in women because of its effects on ovulation and menstruation, but it’s much less concerning now than it was in the past. With adequate control of their condition, women with diabetes are able to get pregnant and have children. However, diabetes complications can drastically affect fertility, so if you have type I diabetes and plan to get pregnant in the near (or not so near) future, the impact of complications on fertility is just one more motivator to get your disease under control.
In men, type I diabetes is associated with low semen volume and decreased sperm activity. Type I diabetes can also trigger erectile dysfunction, further complicating the journey to conception. (Source, Source)
Addison’s is a disease of the adrenal glands, which produce cortisol and other hormones that affect blood pressure and fertility. In particular, people with Addison’s have lower levels of androgens — hormones that contribute to growth and reproduction. The condition significantly reduces a woman’s likelihood of conceiving. One group of researchers found that infertility among women with Addison’s was caused by ovarian insufficiency (or ovarian failure) in 7% of participants, but more research is needed to establish further connections. (Source)
Most women with scleroderma will not experience impaired fertility. However, there’s some evidence that, before disease onset, people with scleroderma who have tried to become pregnant were more likely to struggle with infertility and experience delays in conceiving. Interestingly, women who had never given birth were more likely to have scleroderma than women with children, indicating the presence of unidentified or poorly-understood relationships between scleroderma and fertility. (Source)
How Do Autoimmune Drugs Influence Fertility?
If you have an autoimmune disorder and you’re trying to conceive, it’s essential to consider that even if your particular disease doesn’t cause fertility issues, the medications used to treat it might.
Fortunately, with advances in autoimmune treatment, including the development of new medications and increased awareness of the side effects associated with the drugs, many women who could have been affected by autoimmune drug-induced infertility in the past can now conceive and carry to term. However, many commonly-prescribed autoimmune drugs can affect fertility.