Infertility and subfertility, menstrual irregularities, and decreased parity may occur in women with autoimmune diseases due to multiple factors, including underlying inflammatory disease, gonadotoxic medications, and psychosocial issues related to living with chronic disease. Awareness of these factors, as well as validation and support of patients confronting reproductive challenges, is important for providing comprehensive care to these women. An understanding of the expanding options for fertility preservation strategies during gonadotoxic medications is essential. Referral to a reproductive endocrinology clinic is indicated in this patient population.
Key points
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Women with autoimmune diseases have elevated risk for primary ovarian insufficiency, likely resulting from the underlying inflammatory state, alterations of the hypothalamic-pituitary-gonadal (HPG) axis, and medication exposures.
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Increasingly, more options are available for ovarian preservation alongside gonadotoxic treatment regimens, including strategies for minimizing cumulative exposure of alkylating agents, such as cyclophosphamide (CYC), and the use of adjunctive gonadotropin-releasing hormone analog (GnRH-a) therapy.
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Given that early adulthood and mid-adulthood are periods of increasing risk for development of many autoimmune diseases, particular emphasis on reproductive and family planning issues in this population is of upmost importance.
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