Fertility and Chronic Conditions

It is a matter of little debate that some chronic conditions may affect fertility potential. There is some growing evidence to suggest that thyroid disorders, for instance, can affect fertility as well as impact pregnancy outcome.

Generally speaking, the impact of chronic conditions can be systemic or more often localised to the reproductive organs, such as the uterus in the case of endometritis or the fallopian tubes in the case of hydrosalpinx. Of note, chronic conditions which may affect the body systemically are either hormonal or autoimmune. These may affect the ability to conceive but also affect the stages of pregnancy.

Pregnancies achieved by women with underlying chronic conditions may be at higher risk and as such should be overseen by a dedicated team of Fetal Maternal Medicine Specialists, linked with a wider Multidisciplinary Team.

Not all chronic conditions negatively affect the reproductive outcome of IVF-ICSI cycles, however appropriate investigations should be carried out before women are advised to embark on fertility treatment and where appropriate tailored treatment strategies should be employed.

In this day and age the advances in embryo cryopreservation allow for deferred embryo transfer procedures, so to ensure that the endometrial environment is optimal for successful implantation in women that have a chronic condition which may impact on the ability of an embryo to successfully implant.

Innovations in the field of assisted conception have also helped to overcome some seemingly insurmountable barriers to enhance the chances of successful pregnancy outcome. The introduction of surgical sperm retrieval procedures associated with ICSI have provided effective treatment for male infertility. The advent for preimplantation genetic testing has provided couples with genetic linked diseases and those at increased risk of having aneuploid embryos with the possibility to have healthy children.

Expanded access to international data sets will further enhance the knowledge on the impact that certain chronic diseases have on fertility outcome and the potential benefits of IVF based techniques in creating healthy children.