Auto-immune and fertility

Fertility can be a challenge in life that no woman, man, or couple saw coming. In a life where we often spend years trying to avoid pregnancy, sometimes the reality of conception and pregnancy can take us by surprise. As it turns out, getting pregnant and carrying a baby to term isn’t as easy as many of us thought. Current research suggests 10-15% of couples might face fertility struggles and those numbers increase with age. Infertility becomes an applicable word once a couple has tried for a year to conceive and has not yet achieved pregnancy.

The ability to achieve and hold a pregnancy can be impacted by a myriad of components. Seriously, the list is long: insulin surges, oxidative stress, dysbiosis (disruption of the microbiome), hepatic biotransformation, endocrine disruptors, toxin exposure, prostaglandin imbalances, hyperprolactinemia, PCOS or endometriosis, hypo or hyperglycemia, thyroid dysfunction, nutrient deficiencies, antiphospholipid syndrome, genetics, autoimmunity, and more. The even more challenging concern here is it’s rarely simply one of these concerns but rather a combination of multiple. Then of course you always have to consider the role of sperm quality as well. Just as all these systems and mechanisms are connected, the role of both healthy egg and sperm is equally important.

When you put it this way and when you do what we do- you start to truly, deeply realize how magical it is to have a baby.

Today, we’re going to take a small glimpse into just one of the contributors to that long list of possibilities: Autoimmune disease. These disorders can certainly play a role in reproductive issues and may especially play a role in unexplained cases of infertility and recurrent miscarriages. Women are disproportionately more likely to suffer from autoimmune disease when compared to men, accounting for 78% of all diagnoses. In infertility, with an autoimmune component inflammatory processes may be involved, or antibodies may be directed against certain hormones, clotting factors, or reproductive tissues such as the ovaries or even the placenta.

It is known that autoimmune diseases such as diabetes, autoimmune thyroiditis, systemic lupus erythematosus, and celiac disease are linked to decreased fertility. When you work with autoimmunity, you know that you always have to consider more where there is one. Tissues that can be affected by autoimmunity and often go overlooked include the ovaries, the testes, and antiphospholipid syndrome. Further, it should be noted that other causes of infertility such as endometriosis, polycystic ovarian syndrome, or premature ovarian failure often have autoimmune components (thus why we say it’s rarely one thing and often a combination of multiple).

Hashimoto’s, a particularly common type of autoimmune thyroiditis, is perhaps one of the most recognized autoimmune contributors to fertility struggles. It involves the immune system attacking the thyroid gland, which eventually becomes damaged and leads to malfunction. The autoantibodies present in Hashimoto’s can also bind to granulosa cells in the ovary and affect developing oocytes and lead to ovarian inflammation. Decreased thyroid function, as well as ovarian dysfunction, can impede ovulation, which is essential for pregnancy to occur. T3 hormone, produced by the thyroid, also helps thicken the endometrial lining in preparation for a fertilized egg. Thyroid receptors on the endometrium are important for implantation as well as the maintenance of pregnancy.

In addition, hypothyroidism often causes a change in cortisol- likely increasing cortisol levels in your blood. The increase in cortisol is what is often called the “cortisol steal”. As we talked about in our previous blog post, higher levels of cortisol will steal progesterone and can lead to estrogen dominance. Estrogen dominance is a hormonal imbalance that can also contribute to fertility struggles. If cortisol is pulling more attention than progesterone, we also often see what’s referred to as a “luteal phase defect.” This is extremely common, and we often look for this in women whose full menstrual cycle is fewer than 28 days. Low progesterone can cause complications in implantation and can also increase the risk of miscarriage and progesterone should continue to increase after implantation.

Hyperprolactinemia is a common complication in patients diagnosed with autoimmune diseases such as systemic lupus erythematosus (SLE) rheumatoid arthritis (RA), Sjogren's syndrome (SS), Hashimoto's thyroiditis (HT), and multiple sclerosis (MS). In women, too much prolactin can also cause menstrual problems and infertility as it reduces the release of gonadotropins such as follicle-stimulating hormone (needed for optimal egg quality) and luteinizing hormone (needed to trigger ovulation). It’s not uncommon to see elevated prolactin levels in women experiencing amenorrhea (the absence of the menstrual cycle).

Celiac disease is more recently coming to light as a contributor to fertility struggles in women, particularly if it is undiagnosed or untreated. The challenge here lies in the fact that celiac disease does not always present with gastrointestinal issues and is therefore not often considered to be a possible factor for fertility patients. Research shows an elevated risk of amenorrhea (missing periods), miscarriage, stillbirth, premature delivery, cesarian delivery, and impaired fetal growth, and reduced birth weight among women with celiac disease. Mechanisms behind reduced fertility and increased complications are still unclear, though altered absorption and subsequent nutritional deficiencies are often found in women with both treated and untreated celiac disease (so on from the list we might also consider microbiome issues). As we learn more about the connection between celiac disease and both fertility as well as pregnancy complications, researchers are paying close attention to the autoantibodies present in celiac disease. Studies conducted on pregnant women with celiac suggest that celiac autoantibodies negatively impact both fetal and maternal portions of the placenta.

Clearly, there are many factors that can disrupt the intricate web of physiological processes that help us to maintain our health and fertility. Due to the complex nature of autoimmune diseases, a personalized and holistic approach is necessary. The autoimmune triad, which is often utilized with both allopathic as well as alternative medicine practitioners, acknowledges three contributory factors to autoimmunity: triggering event/stress, genetic predisposition, and microbiome disruption (or leaky gut). It is essential for any man or woman with autoimmunity to address diet, nutrition, and lifestyle in order to optimize fertility. Whether you have Hashimoto’s, celiac disease, RA, SLE, or otherwise, you should have a conversation with a specialist about nutritional needs. If someone is struggling to achieve pregnancy or experiencing recurrent miscarriage, steps can be taken to test for or support possible autoimmune factors.

Blog co-written by:

Samantha Kloss, MOAM, L.Ac.

Dr. Meghan Gray, DACM, MSHNFM, L.Ac.

Sources:

https://pubmed.ncbi.nlm.nih.gov/17854745/

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(13)70241-8/fulltext

https://www.acam.org/blogpost/1092863/179527/Natural-Treatments-for-Autoimmune-Infertility-Concerns

https://www.hindawi.com/journals/jir/2012/762541/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001971/