Systemic lupus erythematosus (SLE) belongs to a group called auto-immune diseases. The immune cells lose their memory and start attacking other body cells instead of offenders. In SLE, many types of cells are attacked by immune cells including kidney cells (lupus nephritis). It most commonly takes place in young women.
Damage to kidney cells has to be stopped otherwise it will ultimately end in kidney failure. Treatment initially involves steroids. If those do not work, chemotherapy is needed especially cyclophosphamide (pulse cyclophosphamide).
Women who require treatment with cyclophosphamide are at much higher risk for cessation of menses, ovarian failure and menopause. The risk is related to age and total dose of the drug and is estimated to take place in 30 to 60% of women treated.
In addition, the immune cells or the antibodies may also damage the ovary and reduce the number of remaining eggs.
So far, there is no proven remedy to avert the effect of chemotherapy (a class of medicine called GnRH agonists was suggest to convey some protection but the benefit is not proven).Women diagnosed with autoimmune diseases, especially if they require chemotherapy for treatment, can reliably preserve their ability to get pregnant in the future by freezing their egg or embryos for later use after disease treatment and remission.
If you were diagnosed with lupus nephritis consider
1. Asking your physician about the effects of lupus and medication used on future fertility.
2. Consulting with high risk obstetrician on the effect of pregnancy on the kidney and the effect of lupus and medication on the fetus. Obtain records of the disease especially the results of kidney biopsy.
3. Discussing with a fertility preservation specialist methods of preserving your future ability to conceive prior to initiation of treatment.
Call to action; just because it’s not cancer does not mean it won’t affect your fertility. Chemotherapy for autoimmune diseases (e.g lupus) can markedly reduce your ability to conceive in the future. This does not have to be the case!