Receiving a diagnosis of a rheumatological disease involves much more than following a treatment plan: it's about learning to live with a chronic illness, adapting to new habits, and facing fears and uncertainties. Among the most common of these is the fear that the disease or its treatment may interfere with the desire to become a mother.
Having a rheumatological disease does not mean giving up the desire to start a family; the key is in anticipating. Understanding how the disease can affect fertility, recognizing the impact of treatment, and exploring the available options for preserving it are essential steps for making informed decisions and safeguarding your reproductive future.
What are Rheumatological Diseases and How Do They Affect Fertility?
Rheumatological diseases include a group of chronic inflammatory conditions that primarily affect the joints, though they can impact other organs as well. Among the most common diseases in women of reproductive age are systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, and antiphospholipid syndrome.
These diseases can affect fertility in several ways:
- By the disease itself: systemic inflammation, immune system imbalances, and hormonal alterations can reduce ovarian reserve, cause menstrual disorders, or interfere with ovulation.
- By the treatments: some medications, such as cyclophosphamide, can cause irreversible ovarian damage. Others, such as methotrexate or mycophenolate, do not directly affect fertility but can harm embryos and must be stopped in advance if pregnancy is desired.
- By general health: chronic pain, fatigue, or frequent flare-ups can make family planning more difficult.
Options for Fertility Preservation
Thanks to improvements in assisted reproduction , it is now possible to preserve fertility safely and according to each individual's situation and life stage.
- Egg Cryopreservation: This involves stimulating the ovaries to retrieve multiple eggs, which are then vitrified (frozen) for future use. This is the most commonly used and recommended technique for young women who are about to undergo treatments that could affect their fertility or who wish to postpone motherhood for medical reasons.
- Ovarian Tissue Preservation: This is done in specific situations, such as for girls, adolescents, or women who need to start treatment immediately and cannot wait for ovarian stimulation.
- GnRH Analog Treatment: Some studies suggest that these medications can partially protect the ovaries during aggressive treatments, though they do not replace vitrification.
Men with rheumatological diseases can also experience fertility challenges. The most suitable option for them is sperm freezing before starting any treatment that may affect sperm quality.
Planning Pregnancy: When and How
For women with rheumatological diseases, pregnancy planning not only increases the chances of success but also helps ensure a safer pregnancy for both the mother and the baby. Some key points are:
- Seek pregnancy during a disease remission phase: Ideally, the disease should be well-controlled for at least 6-12 months before conception.
- Review the treatment in advance: Some medications are contraindicated during pregnancy and must be replaced with safe alternatives well in advance.
When is the Right Time to Consult?
Ideally, you should consult a fertility specialist as soon as you receive the diagnosis, especially if aggressive treatments are anticipated. Even if immediate pregnancy is not desired, knowing all available options allows for informed decision-making in a timely manner.
Preserve Today to Decide Tomorrow
Having a rheumatological disease does not mean giving up the desire to become a mother. However, it does mean planning for it consciously and with professional support. Preserving your fertility is a way to take care of yourself today while thinking about tomorrow.
Dr. Cristina Guix
Gynecologist and Fertility Expert at Barcelona IVF
