Autoimmune diseases such as celiac disease, chrones disease, lupus and inflammatory bowel disease seem to be on the rise in the last 20 years.
Might these diseases be associated with infertility?
In todays segment, Dr Alan Martinez discusses autoimmune diseases, their possible link to infertility and the treatment options available for women with an autoimmune disease that are trying to get pregnant.
Selected Podcast
Autoimmune Diseases and Infertility
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After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Learn more about Dr. Alan Martinez
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Learn more about Dr. Alan Martinez
Transcription:
Autoimmune Diseases and Infertility
Melanie Cole (Host): Autoimmune disease is such a silly Crohn’s, lupus, and inflammatory bowel disease have seemed to be on the rise in the last 20 years, might these disease and others be associated with infertility? My guest today is, Dr. Alan Martinez, he’s a specialist in reproductive endocrinology and infertility, at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez, so which specific autoimmune diseases are known to impact fertility? What do we know and what don’t we know?
Dr. Alan Martinez (Guest): Well, thank you for having me on the show today, I appreciate it. I, first wanted to just talk a little bit about the main diseases, they include lupus, coeliac, some autoimmune thyroid issues. So, autoimmune conditions that can actually decrease the function of the ovaries themselves. Endometriosis is thought to have a component, as well as polycystic ovary syndrome, and some of the issues that are related to recurring pregnancy loss, some of the antibodies even without syndromes. So, your immune system reacting and having specific antibodies can be related to miscarriages and infertility in the population.
Melanie: Since there’s so many, up to 80 autoimmune conditions, do we know if there’s any tests available to see if these, like recurrent pregnancy loss or infertility, might be a problem if somebody knows that they have one of these diseases?
Dr. Martinez: Well, yes. First of all, you want to control if you’ve been diagnosed with an autoimmune disease, especially things like lupus and advanced coeliac disease, Crohn’s, those kind of autoimmune disease, you want to control them before trying to get pregnant. Now, as far as recurrent pregnancy loss, we know that there are specific antibodies that can be tested for within the blood, that directly relate to pregnancy loss, that is miscarriages before 12 weeks early in the pregnancy, and these blood tests, if test…if they’re positive, then you can consider treatments to alleviate possibly any effects of infertility or early pregnancy loss.
Melanie: So, if people know that they have one of these, Dr. Martinez, and they do want to go on fertility treatments, would any of the common fertility drugs cause flares in their autoimmune symptoms? How do those two things go together?
Dr. Martinez: Well, most of the time, these patients are lucky when they through fertility treatments that it, in majority of the time does not directly impact their existing disorder. So, we have several lupus patients, as long as they’re well controlled, they go through fertility treatments and overall patients do very well. So, in most cases, if you have the disease under control, at least in the fertility treatments, patients, overall, do very well. Now, in pregnancy some of these conditions may indeed have an impact, and they may actually worsen during pregnancy, but as far as fertility treatments, patients do well.
Melanie: So, then let’s reverse that. What about the medications for Crohn’s or lupus or any of these things like prednisone, are they safe to take while someone is trying to conceive or while they’re pregnant?
Dr. Martinez: That is a very good question, and you need to discuss that personally with your physicians, whether you have an infertility physician or OBGYN, or a high-risk pregnancy specialist, because there are certain medicine, such as prednisone, and those steroids that can negatively impact the ability to conceive or carry a child. So, that needs to be reviewed, and I don’t want to go into a specific discussion because there’s many different kinds of medicines, but you have to be careful of the medicines that alter the levels of estrogen, progesterone in the body because those things can have a negative impact on achieving and maintaining a pregnancy.
Melanie: And well, we’re not specifically discussing, Dr. Martinez, certain ones, but more serious ones, like MS, for example, have so many medications, and some of these medications are pretty high-end and serious medications. How does somebody go about finding a fertility specialist that understands a disease like MS?
Dr. Martinez: Well, I think that, no matter what fertility specialist that you go to, I think listening to your patient, taking an extensive medical history, and also working in collaboration with their existing physicians, whether it be infectious disease doctor, a rheumatologist, an autoimmune specialist. In today’s world, the more we learn about the molecular side of medicine, we know that it is multi-factorial in collaborations between physicians. So, even if your physician is not an expert, say in lupus infertility or one of the other diseases, it is important for them to listen to you till you feel comfortable with them, and to discuss openly with their remaining team of physicians and providers to best prepare you for pregnancy.
Melanie: When people are going to their OB/GYN, and planning a pregnancy at the beginning, and they’re told to try to conceive for a full year before investigating further treatments with a history of autoimmune diseases, is that still the recommendation or not so much?
Dr. Martinez: Not so much. In any condition exponentially, directly impact your fertility. I think it’s good to discuss it early with your OB/GYN, and seek referral because I think early evaluation, management of your existing disorder, disease is going to be critical, and sometimes it takes multiple months or even years in order to control your existing condition. So, I think that a lot of the normal timeframes that apply to the healthy patients without any chronic disease, you can disregard those, and there’s nothing wrong with asking and seeking education and advice early on.
Melanie: Have you seen in your practice that some women who are having fertility issues are actually dealing with an autoimmune-based problem that had not been diagnosed?
Dr. Martinez: Absolutely, we see many patients who have several early miscarriages, we do some initial blood work for them, we find that they have some antibodies present that are specifically related to negative outcomes, they may be placed on medications, and often times, this helps them achieve pregnancy.
Melanie: And what can you tell them about what they can expect if you’ve helped them to get pregnancy, and during their pregnancy, and even postpartum, the improvement or worsening of some of their symptoms, is this something you can give them advice about and help them understand?
Dr. Martinez: Absolutely, I serve as kind of the preliminary advisor once they become pregnant, but yet again it’s a collaborative effect, collaborative effort. So, it’s important that when you do achieve pregnancy, that we sit down and we discuss your existing disorder, and we get you plugged in with the right physicians that can then continue good and timely care throughout the remainder of your pregnancy to give you the highest chance of success.
Melanie: So, sometimes more than one physician will be working with this particular woman or couple, and how is the communication between physicians, based on this patient?
Dr. Martinez: Yes, in many conditions when people with autoimmune conditions, and they’re on certain medications when they achieve pregnancy, we directly refer them back to their OB/GYN, but we also recommend that they get a high-risk obstetrics physician involved, a maternal fetal medicine specialist, and we may talk to them over the phone, we may communicate via electronic means, but you can rest assured that you’re going to be counselled and appropriately triaged to a physician that are going to maximize your pregnancy.
Melanie: So, what would you like women to know, that may already know that they have some of these autoimmune diseases, and the connection between fertility difficulties and autoimmune conditions. What would you like to tell them, Dr. Martinez?
Dr. Martinez: I’d like to say, it’s very important that you control and maintain a good relationship with your existing providers with regards to your specific autoimmune condition, and if not diagnosed or not under control, we can always sit down and talk about things very early on when you’re considering conceiving, and then it’s important to use the collaborative physician approach, in order for us to best prepare your body, in order to have a successful pregnancy. So, we’re happy to navigate that, and I think early intervention and early counselling and visits to a physician such as myself is integral component to pregnancy success.
Melanie: So, tell us just a little bit about the Reproductive Science Center of New Jersey, and how you can help these women?
Dr. Martinez: Yes, we’re at Reproductive Science Center of New Jersey. We treat everyone as an individual, and we sit down with you and take an extensive medical history, a physical exam, and we obtain all information with regards to your medical history that’s going to be crucial to establishing how difficult it may be to get you pregnant, especially in light of these autoimmune disorders. So, our important thing is we want to treat everybody like family, and that’s very critical to our success and our longevity in this practice. So, when you come to see us, you will establish that relationship and you can rest assured that you’re in good hands with us.
Melanie: Thank you so much, Dr. Martinez, for being with us today. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey, and for more information, you can go to, FertilityNJ.com, that’s FertilityNJ.com. This is Melanie Cole, thanks so much for listening.
Autoimmune Diseases and Infertility
Melanie Cole (Host): Autoimmune disease is such a silly Crohn’s, lupus, and inflammatory bowel disease have seemed to be on the rise in the last 20 years, might these disease and others be associated with infertility? My guest today is, Dr. Alan Martinez, he’s a specialist in reproductive endocrinology and infertility, at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez, so which specific autoimmune diseases are known to impact fertility? What do we know and what don’t we know?
Dr. Alan Martinez (Guest): Well, thank you for having me on the show today, I appreciate it. I, first wanted to just talk a little bit about the main diseases, they include lupus, coeliac, some autoimmune thyroid issues. So, autoimmune conditions that can actually decrease the function of the ovaries themselves. Endometriosis is thought to have a component, as well as polycystic ovary syndrome, and some of the issues that are related to recurring pregnancy loss, some of the antibodies even without syndromes. So, your immune system reacting and having specific antibodies can be related to miscarriages and infertility in the population.
Melanie: Since there’s so many, up to 80 autoimmune conditions, do we know if there’s any tests available to see if these, like recurrent pregnancy loss or infertility, might be a problem if somebody knows that they have one of these diseases?
Dr. Martinez: Well, yes. First of all, you want to control if you’ve been diagnosed with an autoimmune disease, especially things like lupus and advanced coeliac disease, Crohn’s, those kind of autoimmune disease, you want to control them before trying to get pregnant. Now, as far as recurrent pregnancy loss, we know that there are specific antibodies that can be tested for within the blood, that directly relate to pregnancy loss, that is miscarriages before 12 weeks early in the pregnancy, and these blood tests, if test…if they’re positive, then you can consider treatments to alleviate possibly any effects of infertility or early pregnancy loss.
Melanie: So, if people know that they have one of these, Dr. Martinez, and they do want to go on fertility treatments, would any of the common fertility drugs cause flares in their autoimmune symptoms? How do those two things go together?
Dr. Martinez: Well, most of the time, these patients are lucky when they through fertility treatments that it, in majority of the time does not directly impact their existing disorder. So, we have several lupus patients, as long as they’re well controlled, they go through fertility treatments and overall patients do very well. So, in most cases, if you have the disease under control, at least in the fertility treatments, patients, overall, do very well. Now, in pregnancy some of these conditions may indeed have an impact, and they may actually worsen during pregnancy, but as far as fertility treatments, patients do well.
Melanie: So, then let’s reverse that. What about the medications for Crohn’s or lupus or any of these things like prednisone, are they safe to take while someone is trying to conceive or while they’re pregnant?
Dr. Martinez: That is a very good question, and you need to discuss that personally with your physicians, whether you have an infertility physician or OBGYN, or a high-risk pregnancy specialist, because there are certain medicine, such as prednisone, and those steroids that can negatively impact the ability to conceive or carry a child. So, that needs to be reviewed, and I don’t want to go into a specific discussion because there’s many different kinds of medicines, but you have to be careful of the medicines that alter the levels of estrogen, progesterone in the body because those things can have a negative impact on achieving and maintaining a pregnancy.
Melanie: And well, we’re not specifically discussing, Dr. Martinez, certain ones, but more serious ones, like MS, for example, have so many medications, and some of these medications are pretty high-end and serious medications. How does somebody go about finding a fertility specialist that understands a disease like MS?
Dr. Martinez: Well, I think that, no matter what fertility specialist that you go to, I think listening to your patient, taking an extensive medical history, and also working in collaboration with their existing physicians, whether it be infectious disease doctor, a rheumatologist, an autoimmune specialist. In today’s world, the more we learn about the molecular side of medicine, we know that it is multi-factorial in collaborations between physicians. So, even if your physician is not an expert, say in lupus infertility or one of the other diseases, it is important for them to listen to you till you feel comfortable with them, and to discuss openly with their remaining team of physicians and providers to best prepare you for pregnancy.
Melanie: When people are going to their OB/GYN, and planning a pregnancy at the beginning, and they’re told to try to conceive for a full year before investigating further treatments with a history of autoimmune diseases, is that still the recommendation or not so much?
Dr. Martinez: Not so much. In any condition exponentially, directly impact your fertility. I think it’s good to discuss it early with your OB/GYN, and seek referral because I think early evaluation, management of your existing disorder, disease is going to be critical, and sometimes it takes multiple months or even years in order to control your existing condition. So, I think that a lot of the normal timeframes that apply to the healthy patients without any chronic disease, you can disregard those, and there’s nothing wrong with asking and seeking education and advice early on.
Melanie: Have you seen in your practice that some women who are having fertility issues are actually dealing with an autoimmune-based problem that had not been diagnosed?
Dr. Martinez: Absolutely, we see many patients who have several early miscarriages, we do some initial blood work for them, we find that they have some antibodies present that are specifically related to negative outcomes, they may be placed on medications, and often times, this helps them achieve pregnancy.
Melanie: And what can you tell them about what they can expect if you’ve helped them to get pregnancy, and during their pregnancy, and even postpartum, the improvement or worsening of some of their symptoms, is this something you can give them advice about and help them understand?
Dr. Martinez: Absolutely, I serve as kind of the preliminary advisor once they become pregnant, but yet again it’s a collaborative effect, collaborative effort. So, it’s important that when you do achieve pregnancy, that we sit down and we discuss your existing disorder, and we get you plugged in with the right physicians that can then continue good and timely care throughout the remainder of your pregnancy to give you the highest chance of success.
Melanie: So, sometimes more than one physician will be working with this particular woman or couple, and how is the communication between physicians, based on this patient?
Dr. Martinez: Yes, in many conditions when people with autoimmune conditions, and they’re on certain medications when they achieve pregnancy, we directly refer them back to their OB/GYN, but we also recommend that they get a high-risk obstetrics physician involved, a maternal fetal medicine specialist, and we may talk to them over the phone, we may communicate via electronic means, but you can rest assured that you’re going to be counselled and appropriately triaged to a physician that are going to maximize your pregnancy.
Melanie: So, what would you like women to know, that may already know that they have some of these autoimmune diseases, and the connection between fertility difficulties and autoimmune conditions. What would you like to tell them, Dr. Martinez?
Dr. Martinez: I’d like to say, it’s very important that you control and maintain a good relationship with your existing providers with regards to your specific autoimmune condition, and if not diagnosed or not under control, we can always sit down and talk about things very early on when you’re considering conceiving, and then it’s important to use the collaborative physician approach, in order for us to best prepare your body, in order to have a successful pregnancy. So, we’re happy to navigate that, and I think early intervention and early counselling and visits to a physician such as myself is integral component to pregnancy success.
Melanie: So, tell us just a little bit about the Reproductive Science Center of New Jersey, and how you can help these women?
Dr. Martinez: Yes, we’re at Reproductive Science Center of New Jersey. We treat everyone as an individual, and we sit down with you and take an extensive medical history, a physical exam, and we obtain all information with regards to your medical history that’s going to be crucial to establishing how difficult it may be to get you pregnant, especially in light of these autoimmune disorders. So, our important thing is we want to treat everybody like family, and that’s very critical to our success and our longevity in this practice. So, when you come to see us, you will establish that relationship and you can rest assured that you’re in good hands with us.
Melanie: Thank you so much, Dr. Martinez, for being with us today. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey, and for more information, you can go to, FertilityNJ.com, that’s FertilityNJ.com. This is Melanie Cole, thanks so much for listening.