Autoimmune diseases frequently affect young women in their fertile phase. In particular, rheumatological diseases such as collagenosis and vasculitis continue, despite major advances in treatment, to be frequent reasons for chemotherapy, e.g. with cyclophosphamide. If diagnosed early and after initiation of an appropriate therapy, most patients can be treated effectively and permanently nowadays. Therefore, fertility preservation plays an increasingly important role.
The autoimmune disease itself often already limits ovarian reserve. Additionally, the cyclophosphamide therapy increases the risk of premature ovarian function depletion (= premature ovarian insufficiency, POI) and depends on the age of the patient and the total dose. Therefore, patients with autoimmune diseases should be counselled with respect to fertility preservation.
Three fertility preservation methods can be initiated: using a GnRHa to protect ovarian function, freezing ovarian tissue, or freezing unfertilized eggs. The choice of fertility-preserving measure including the assessment of the possible risks is an individual decision that should be made together with the patient, the responsible gynaecologist and the treating rheumatologist.
Importantly, the appointment visit? at a reproductive medicine centre should be made as early as possible in order to have a large time window for the implementation of any of the fertility-preserving measures.
One way to facilitate the patient’s decision after the consultation regarding fertility-preserving measures is the “Decision Aid” linked here. This digital decision aid has been developed by psychologists, psychotherapists and reproductive physicians and might help in an individual situation.