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.

Detailed inform­a­tion and a bib­li­o­graphy can be found in the Fer­ti­PRO­TEKT booklet “Indika­tion und Durch­führung fer­til­ität­s­pro­tekt­iver Maßnahmen bei onko­lo­gis­chen und nicht-onko­lo­gis­chen Erkrankun­gen”, 2nd revised edition 2020, which was written by members of the Fer­ti­PRO­TEKT Netzwerk e.V. and is available free of charge (in German).

An english version can be bought: Fertility Pre­ser­va­tion in Onco­lo­gic­al and Non-Onco­lo­gic­al Diseases a practical guide by Michael von Wolff & Frank Nawroth ISBN 978–3‑030–47567‑3 from