Endocrine autoimmune diseases and female infertility

Sen, Aritro; Kushnir, Vitaly A.; Barad, David H.; Gleicher, Norbert

doi:10.1038/nrendo.2013.212

Cited by 98 publications

(90 citation statements)

References 173 publications

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“…At least some of these conditions, for example autoimmune diseases, can affect fertility potential [68,69] and/or raise outcome risks for mothers and offspring [69-73]. Prospective risk management, therefore, becomes essential in older women to avoid preventable pregnancy losses and other complications at varying gestational stages.…”

Section: Resultsmentioning

confidence: 99%

The “graying” of infertility services: an impending revolution nobody is ready for

Gleicher

Kushnir

Weghofer

et al. 2014

Reprod Biol Endocrinol

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BackgroundAs demand for infertility services by older women continues to grow, because achievable in vitro fertilization (IVF) outcomes are widely underestimated, most fertility centers do not offer maximal treatment options with use of autologous oocytes. Limited data suggest that clinical IVF outcomes in excess of what the American Society for Reproductive Medicine (ASRM) considers “futile” can, likely, be achieved up to at least age 45 years.MethodsIn an attempt to point out an evolving demographic trend in IVF, we here report our center’s IVF data for 2010-2012 and national U.S. data for 1997-2010. Though our center’s data are representative of only one IVF center’s patients, they, likely, are unique since they probably represent the most adversely selected IVF patient population ever reported and, thus, are predictive of future demographic trends. In addition we performed a systematic review of the literature on the subject based on PubMed, Medline and Google Scholar searches till year-end 2013. The literature search was performed using key words and phrases relevant to fertility treatments in older women.ResultsAs demonstrated by our center’s patient demographics and national U.S. data, IVF centers are destined to treat increasingly adversely selected patients. Despite our center’s already extremely adversely selected patient population, age-specific IVF cycle outcomes in women above age 40 years, nevertheless, exceeded criteria for “futility” by the ASRM and widely quoted outcome expectations in the literature for patient ages. Age 43 discriminates between better and poorer clinical pregnancy and live birth rates.Conclusions“Graying” of the infertility populations in the developed world, a problem with potentially far-reaching medical and societal consequences, has so far been only insufficiently addressed in the literature. As women’s postmenopausal life spans already exceed postmenarcheal life spans at the start of the 20th century, the “graying” of infertility services can be expected to further accelerate, no longer as in recent decades bringing only women in their 40s into maternity wards but also women in their 50s and 60s. Medicine and society better get ready for this revolution.

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Section: Resultsmentioning

confidence: 99%

The “graying” of infertility services: an impending revolution nobody is ready for

Gleicher

Kushnir

Weghofer

et al. 2014

Reprod Biol Endocrinol

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“…A comprehensive list of all systemic conditions that have been demonstrated to have a significant negative influence on embryonic implantation is difficult to compile; however, conditions such as unstable diabetes (64), subclinical hypothyroidism (356), periodontal disease (144), and uncontrolled celiac disease (343) have been demonstrated to reduce rates of conception, and it is believed that low serum vitamin D (199) and active autoimmune conditions (304) are also associated with a reduced chance of conception, and strategies to control these conditions may improve conception chances. Due to their high prevalence and ease of correction of the abnormality, celiac disease and subclinical hypothyroidism are discussed further.…”

Section: Systemicmentioning

confidence: 99%

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Hart

2016

Physiological Reviews

162

121

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Across the Western World there is an increasing trend to postpone childbearing. Consequently, the negative influence of age on oocyte quality may lead to a difficulty in conceiving for many couples. Furthermore, lifestyle factors may exacerbate a couple's difficulty in conceiving due mainly to the metabolic influence of obesity; however, the negative impacts of low peripheral body fat, excessive exercise, the increasing prevalence of sexually transmitted diseases, and smoking all have significant negative effects on fertility. Other factors that impede conception are the perceived increasing prevalence of the polycystic ovary syndrome, which is further exacerbated by obesity, and the presence of uterine fibroids and endometriosis (a progressive pelvic inflammatory disorder) which are more prevalent in older women. A tendency for an earlier sexual debut and to have more sexual partners has led to an increase in sexually transmitted diseases. In addition, there are several genetic influences that may limit the number of oocytes within the ovary; consequently, by postponing attempts at childbearing, a limitation of oocyte number may become evident, whereas in previous generations with earlier conception this potentially reduced reproductive life span did not manifest in infertility. Environmental influences on reproduction are under increasing scrutiny. Although firm evidence is lacking however, dioxin exposure may be linked to endometriosis, phthalate exposure may influence ovarian reserve, and bisphenol A may interfere with oocyte development and maturation. However, chemotherapy or radiotherapy is recognized to lead to ovarian damage and predispose the woman to ovarian failure.

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“…These physiological changes influence the activity of various maternal autoimmune diseases during pregnancy and the post partum period (27,28); therefore, they may have favoured the activation of hypothalamic autoimmunity in our patients, with development of clinically overt CDI. With regard to the persistence of clinical CDI for some months after delivery in both our cases, a particular role could have been played by PRL.…”

Section: Discussionmentioning

confidence: 90%

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

Bellastella

Bizzarro

Aitella

et al. 2015

European Journal of Endocrinology

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Recently, an increased incidence of central diabetes insipidus (CDI) in pregnancy, and less frequently in the post partum period, has been reported, most probably favoured by some conditions occurring in pregnancy. This study was aimed at investigating the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity. We studied the longitudinal behaviour of arginine-vasopressin cell antibodies (AVPcAbs) and post-pituitary function in two young women with a positive history of autoimmune disease and presence of AVPcAbs, but without clinical CDI, and who became pregnant 5 and 7 months after our first observation. The behaviour of post-pituitary function and AVPcAbs (by immunofluorescence) was evaluated at baseline, during pregnancy and for 2 years after delivery. AVPcAbs, present at low/middle titres at baseline in both patients, showed a titre increase during pregnancy in one patient and after delivery in the other patient, with development of clinically overt CDI. Therapy with 1-deamino-8-D-arginine vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month of post partum period respectively, when AVPcAbs disappeared, accompanied by post-pituitary function recovery, persisting until the end of the follow-up. The determination of AVPcAbs is advisable in patients with autoimmune diseases planning their pregnancy, because they could be considered good predictive markers of gestational or post partum autoimmune CDI. The monitoring of AVPcAb titres and post-pituitary function during pregnancy in these patients may allow for an early diagnosis and an early replacement therapy, which could induce the disappearance of these antibodies with consequent complete remission of CDI.

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Endocrine autoimmune diseases and female infertility

Cited by 98 publications

References 173 publications

The “graying” of infertility services: an impending revolution nobody is ready for

The “graying” of infertility services: an impending revolution nobody is ready for

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

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