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A new study has revealed that women who experience infertility but do not use fertility treatments face a heightened risk of developing systemic autoimmune rheumatic diseases (SARD) in the years following childbirth. The research, published in Human Reproduction, highlights a significant connection between infertility and the onset of these debilitating conditions, even when accounting for complications such as pre-eclampsia, preterm birth, and stillbirth—all of which are commonly associated with infertility.
The study, led by Dr. Natalie V. Scime, a Banting Postdoctoral Fellow at ICES and the University of Toronto Scarborough, analyzed data from over half a million births between 2012 and 2021 in Ontario, Canada. The results indicate that women who had infertility without using fertility treatments were 25% more likely to develop SARD within nine years after childbirth, compared to women who did not experience infertility.
SARD, a group of rare yet serious autoimmune conditions, includes diseases such as systemic lupus erythematosus, Sjögren’s syndrome, and inflammatory myopathy. These conditions cause the immune system to mistakenly attack the body’s own tissues, often leading to significant complications like joint pain, skin rashes, kidney inflammation, and muscle weakness. They primarily affect women, especially during their reproductive years.
Dr. Scime noted that previous studies have suggested that women with infertility often show abnormal immune system activity, but until now, little research has explored how this could be connected to autoimmune diseases. The study compared four groups of women: those without infertility, those with infertility who did not use fertility treatments, and those who used non-invasive or invasive fertility treatments. The findings were clear: while fertility treatments did not increase the risk of developing SARD, women with untreated infertility faced a notable increase in risk.
For every 10,000 women followed for a year, nine new cases of SARD were observed in women without infertility, compared to 13 new cases in women who experienced infertility without fertility treatments. Notably, the rates for those who used fertility treatments were similar to those without infertility, which Dr. Scime attributes to the “healthy patient” effect, where women who seek fertility treatments tend to have better overall health and a lower risk of autoimmune diseases.
The study’s findings are particularly significant because SARD can often go undiagnosed for years. Symptoms like unexplained fatigue, joint pain, and skin rashes can overlap with other conditions, making diagnosis challenging. Early detection is crucial to prevent organ damage and improve long-term outcomes for patients.
Dr. Scime emphasized the importance of screening for autoimmune symptoms in women who have experienced infertility, especially during post-pregnancy check-ups. Doctors could use infertility care as an opportunity to detect early signs of autoimmune diseases and refer patients for further evaluation or treatment.
While the study identifies a link between infertility and an increased risk of SARD, the researchers caution that infertility itself may not directly cause these conditions. There are various underlying causes of infertility, such as endometriosis or advanced maternal age, which could contribute to the observed association. The study also lacked detailed information on the specific causes of infertility and other lifestyle factors, which may affect the findings.
Looking forward, Dr. Hilary Brown, Associate Professor at the University of Toronto Scarborough, suggested that future research should explore whether specific infertility causes are more strongly linked to SARD and investigate the biological mechanisms through which these conditions could influence fertility.
The research underscores the need for increased awareness and proactive healthcare for women who have struggled with infertility, ensuring that potential autoimmune conditions are diagnosed and managed early to improve quality of life.
For more information, the study is published in Human Reproduction (2024). DOI: 10.1093/humrep/deae253
