JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):41
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263579

P-29. Autoimmune Diseases in the Context of Infertility: Type 1 Diabetes Mellitus and Systemic Lupus Erythematosus and Their Reproductive Outcomes

Bruna Maia Furtado de Figueiredo¹, Nara Santos Guerra¹, Marina Norões¹, Marina Simões¹, Marcelo Cavalcante¹

¹UNIFOR - Universidade de Fortaleza - Fortaleza - CE - Brasil

Objective: This study aims to investigate how type 1 diabetes mellitus and systemic lupus erythematosus influence female infertility and identify their main effects on reproductive outcomes.
Methods: This is an integrative review based on the guiding question: “In women of reproductive age with DM1 or SLE, what is the impact of these autoimmune diseases on infertility and reproductive outcomes, compared to women without autoimmune diseases?”, developed based on the PICO strategy - Population, Intervention, Comparison, and Outcomes (da Costa Santos et al.,2007). A search was conducted in the SciELO, PubMed, and Embase databases, using the descriptors: “Autoimmune Diseases,” “Type 1 Diabetes Mellitus,” “Infertility,” “Lupus,” and “reproduction,” combined by the Boolean operators ‘AND’ and “OR.” After the search, the articles were screened in Rayyan, including only publications between 2015 and 2025, in English or Portuguese, related to the guiding question. Case reports, paid works, and those that did not meet the inclusion criteria were excluded.
Results: Of the 429 articles found, 362 were excluded by title; of the remaining 67, 38 were excluded by abstract, leaving 29 for full reading. Of these, 8 were approved for synthesis. After evaluating these studies, it was noted that DM1 impairs female fertility through systemic inflammation, hormonal imbalances, and reduced endometrial receptivity, decreasing the chances of pregnancy and increasing reproductive failures. Even with good glycemic control, there may be a decrease in follicular reserve and anovulatory cycles, with a direct suggestion of an autoimmune component in this condition. In addition, the association with other diseases, such as hypothyroidism, aggravates reproductive dysfunction by intensifying endocrine and inflammatory dysregulation, hindering fertilization. SLE also affects fertility through inflammation, changes in the gonadotropic axis, and an increased risk of uteroplacental thrombosis, impairing ovulation and maintenance of pregnancy. Furthermore, prolonged use of cyclophosphamide—a therapeutic immunosuppressant—is linked to premature ovarian failure and amenorrhea, and the presence of antiphospholipid antibodies increases the risk of infertility, miscarriages, and implantation failures, even in remission, by interfering with follicle maturation and oocyte quality. That said, it is a fact that DM1 and SLE share chronic inflammation, autoantibodies, hormonal dysregulation, oxidative stress, and endothelial dysfunction, compromising ovarian reserve, endometrium, and reproductive function. Early recognition of these effects is essential for multidisciplinary follow-up, strict disease control, and reproductive counseling. Measures such as egg freezing, pregnancy during periods of remission, and judicious use of immunosuppressants are strategies for better outcomes.
Conclusion: Therefore, it was possible to demonstrate the effect that DM1 and SLE have on fertility and, consequently, reproduction. As a result, a multidisciplinary approach is recommended for women with these autoimmune diseases, aiming at optimal follow-up of these patients. Thus, it is important to expand studies that aid in the proper management of these cases.

Reference
da Costa Santos et al. Rev Lat Am Enfermagem. 2007;15:508-11