Women with certain autoimmune diseases face greater difficulty getting pregnant and keep their baby.

Getting pregnant seems simple enough ― all you need is an egg and a sperm to meet, right? Sure, but various mechanisms in your body need to be up to par before this union can successfully create a baby. If you suffer from an autoimmune disorder, this will certainly put a dampener on your pregnancy plans.

Autoimmune disease refers to more than 80 serious, chronic illnesses that involve almost every human organ system, including the reproductive system. Under normal circumstances, the body’s immune system protects it against “foreign” invaders like viruses, bacteria and parasites.

Associate Professor Mahesh Choolani, Senior Consultant, National University Hospital (NUH) Women’s Centre, explains that when a person develops an autoimmune disease, the body’s natural defence mechanisms such as antibodies and Natural Killer (NK) cells attack and destroy its own cells by mistakenly thinking them to be foreign.

About 75 per cent of autoimmune diseases occur in women of mostly child-bearing age. They include…thyroid hormonal disorders and psoriasis.

This means that in response to an unknown trigger, the immune system starts producing antibodies that attack the body’s own tissues instead of fighting infections. When these antibodies are directed against one’s own cells and tissues, they could affect and damage several organs that are crucial to fertility ― this may affect a woman’s ability to conceive and stay pregnant.

About 75 per cent of autoimmune diseases occur in women of mostly child-bearing age. They include rheumatoid arthritis, lupus, inflammatory bowel disease, multiple sclerosis, Guillain-Barre syndrome, thyroid hormonal disorders and psoriasis.

Dr Choolani offers his insights on autoimmune disorders and fertility.

Of the many autoimmune disorders, some have a greater impact on the female reproductive system. What are these?

* Autoimmune thyroiditis This occurs when thyroid cells are damaged by the immune system. Symptoms may vary depending on the thyroid function, whether surfacing as hyperthyroidism or hypothyroidism.

* Diabetes mellitus Symptoms include extreme thirst, passing urine often, weight loss, fatigue and blurred vision.

* Raynaud’s syndrome This condition causes some areas of the body, such as fingers and toes, to feel numb and cold, due to cold temperatures or stress.

* Sjogren’s syndrome Symptoms include a dry mouth and eyes ― the condition is often accompanied by other immune system disorders, such as rheumatoid arthritis and lupus.

* Systemic lupus erythematosus (also known as SLE) The most common and serious form of lupus. Symptoms vary widely and include fatigue, weight loss, joint pain, easy bruising and a butterfly-shaped rash across the face.



Let’s focus on thyroid hormones ― how do they factor in female fertility?

The thyroid is a flat, small gland in the neck and its main job is to control hormone production to help the body regulate how it uses energy. Thyroid autoantibodies could lead to either hyperthyroidism or hypothyroidism:

* Hyperthyroidism An overactive thyroid gland with elevated levels of thyroid hormones (sometimes known as Graves’ disease).

* Hypothyroidism An underactive thyroid gland with low levels of thyroid hormones (sometimes known as Hashimoto's thyroiditis).

These conditions can all potentially lead to female infertility. If your thyroid gland releases too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormones, the balance of reproductive hormones can be impaired and result in fertility issues such as ovulation disorders, irregular periods, and difficulty getting pregnant or carrying a baby to term. A doctor determines this by ordering a blood test for analysis.

This test measures the level of thyroid stimulating hormone (TSH), a kind of master hormone that regulates your thyroid gland to produce more thyroxine. If your TSH is high, it typically means that your thyroid function is too low (hypothyroid). A low level of TSH and high thyroxine, generally means the thyroid is overactive (hyperthyroid.)

“If a woman succeeds in conceiving, she should have her thyroid hormones under close surveillance to ensure they stay within the normal ranges throughout the pregnancy, and be under the care of a high-risk pregnancy clinic.”

What are the key symptoms of hyperthyroidism and hypothyroidism?

Hyperthyroidism The main symptoms are weight loss, intolerance to a warm environment, perspiration, palpitations, sweaty palms, thinning of hair, menstrual changes and palpitations.

Hypothyroidism The main symptoms are weight gain, constipation, fatigue, intolerance to a cold environment, dry skin, puffiness, and occasionally heavy periods.

Is it necessary for all women to test for autoimmune disease if they are planning to get pregnant?

No, this is not necessary. Only those who are suspected to have autoimmune conditions from common physical features such as dry skin, falling hair, heat or cold intolerance, difficulty in conceiving, or recurrent pregnancy losses would need extensive investigations for autoimmune disease.

What treatment can improve a woman’s fertility if she has a thyroid problem?

The thyroid hormones need to be brought into balance. In cases of hyperthyroidism, certain drugs could be used to quiet the thyroid gland, and in cases of hypothyroidism, oral thyroxine could be used to bring the thyroid levels into the normal range.

If a woman succeeds in conceiving, what kind of precautions must she take during the course of her pregnancy?

She should have her thyroid hormones under close surveillance to ensure they stay within the normal ranges throughout the pregnancy, and be under the care of a high-risk pregnancy clinic to ensure that the other endocrine organs are also functioning well, and that the baby continues to develop and grow well.

Photos: iStock

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