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Human Reproduction Update Advance Access originally published online on May 22, 2008
Human Reproduction Update 2008 14(4):359-366; doi:10.1093/humupd/dmn013
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Bidirectional effects on autoimmunity and reproduction

Ricard Cervera1,3 and Juan Balasch2

1 Department of Autoimmune Diseases, Institut Clínic of Medicine and Dermatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain 2 Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

3 Correspondence address. Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Catalonia, Spain. Tel/Fax: +34-93-2275774; E-mail: rcervera{at}clinic.ub.es

BACKGROUND: Autoimmune diseases may selectively affect women in their reproductive years, and conversely, pregnancy may affect the expression of autoimmune disease. This review addresses the impact of abnormal autoimmunity on female fertility, premature ovarian failure (POF) and recurrent pregnancy loss, as well as the influence of pregnancy in systemic lupus erythematosus (SLE).

METHODS: From a PubMed search, citations were selected for their immunological and gynecological relevance.

RESULTS: The presence of antiphospholipid antibody (aPL) does neither correlate with the type of female infertility diagnosis nor affect outcomes, and treatment is not indicated. Autoimmunity as a cause of POF is probably limited to the cases associated with the autoimmune thyroid diseases. With respect to recurrent spontaneous abortion, there is no consensus on the mechanisms of an autoimmune effect, although vasculopathy of the terminal spiral arteries may be implicated, but there is a general consensus to screen for aPL when recurrent spontaneous abortion is unexplained. Well-designed diagnostic studies are needed to estimate the true association between specific autoantibodies and recurrent spontaneous abortion. With respect to SLE, pregnancy should be avoided when the disease is active, and the potentially harmful impact of pregnancy can be minimized by multi-disciplinary care.

CONCLUSIONS: Autoimmunity may impair female fertility and, in particular, the antiphospholipid syndrome is associated with recurrent spontaneous abortion. Integration of mechanistic and clinical information by multi-disciplinary teams is needed to manage reproductive issues in women with autoimmune diseases.

Key words: infertility / pregnancy loss / systemic lupus erythematosus / antiphospholipid antibodies

Received on November 28, 2007; revised March 26, 2008; accepted on April 21, 2008


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