The Impact of Inflammation & Autoimmunity On Female Fertility

There is a growing body of research on the role of the immune system in fertility and pregnancy outcomes. Although there are still many areas where further research is needed, the current literature clearly links autoimmunity to troubles with conception; therefore it is essential to understand the underlying mechanisms of inflammation and autoimmunity and their effects on the reproductive system.

In this blog post, we will explore the impact of inflammation and autoimmunity on female fertility and discuss how nutritional therapy can be used to support fertility in women with these conditions.

NB: Please consult with a medical practitioner before starting any new dietary protocol or supplementation plan.

Some of the most common autoimmune conditions, including Hashimoto’s thyroiditis, Graves disease, coeliac disease, and endometriosis can affect many body functions, especially the fine hormonal balance that supports female fertility. However, that’s just half the picture as the inflammation associated with immune dysregulation can affect fertility, particularly implantation.

Autoimmunity: The Thyroid & Fertility

Hashimoto’s hypothyroidism can increase prolactin levels, lower oestrogen and contribute to weight gain that in turn, via increased aromatisation (the conversion of testosterone into oestrogen), can dysregulate oestrogen levels affecting the menstrual cycle, including inhibiting ovulation and causing luteal phase defects.

Additionally, in autoimmune thyroiditis inflammation becomes an issue, which from a functional medicine perspective, is imperative to address in order to support balanced immunity and fertility.

Investigating dietary or lifestyle factors that may contribute to autoimmune conditions or feed systemic inflammation is a priority of the functional medicine approach. Usual suspects include:

• Gluten, not just testing for coeliac disease (which is a must), but also sensitivity, especially if there are any digestive mood or energy symptoms because of its overwhelming pro-inflammatory effects;

• As well as dairy for the same reasons, plus the additional hormones and growth factors that can also affect hormonal balance and fertility.

Excess weight and stress are also contributors to inflammation and must be addressed to support fertility.

In infertility cases when there is suspected inflammation, I recommend a Mediterranean diet. In cases of confirmed autoimmune issues and fertility/miscarriage concerns, I recommend a modified anti-inflammatory style approach that is tailored to the individual.

The Inflammatory Effects of Endometriosis On Fertility

Endometriosis can impair fertility in various ways. First because of anatomical changes that can affect implantation, such as scar tissue; lower endometrial receptivity (period of implantation), and ovulatory dysfunction that in turn can prevent egg maturation and fertilisation.

All of the above are rooted in immune dysfunction, and the associated inflammatory cascade can have a detrimental impact on the fine balance of the immune system, which is necessary for successful embryo implantation.

Endometriosis affects the natural killer (NK) cell balance in the uterus, which is fundamental in implantation and early stages of pregnancy, but even before implantation, fertilisation may be affected by the effects of fluid surrounding the fallopian tubes, which have been found to contain high levels of pro-inflammatory cytokines, hormones and growth factors on sperm mobility.

Endometriosis is characterised by an overproduction of inflammatory mediators, higher oxidation, and lower total antioxidant potential - meaning individuals with endometriosis have both more inflammation and less ability to cope with inflammation.

From the nutritional perspective, anti-inflammatory agents like vitamin C, vitamin E, selenium, EPA omega 3 fatty acids, and quercetin can help modulate the inflammatory response. N-acetyl-cysteine and diindolylmethane can help eliminate excess oestrogen and reduce the severity of the inflammation.

A diet high in vegetables, phytonutrients, and plant fibre is indicated to increase sex hormone binding globulin and eliminate access oestrogen. Lignans in flax can modulate oestrogen receptors reducing the severity of the hormone-active endometrial lesions. Foods low in animal fats, especially dairy and fatty meat (which can contain oestrogen and are also pro-inflammatory) and high in fish (including oily fish) and fresh vegetables, especially those from the Brassica family to help metabolise, oestrogen are advisable in excess oestrogen situations.

However, many cases of endometriosis are active regardless of high levels of oestrogen due to the auto-inflammatory aspects of the disease, so it is important to find out the individual underlying mechanisms driving your particular case of endometriosis.

Food Allergies & Sensitivities

Food allergies and sensitivities are worth looking into, to help identify and remove any foods causing cross-reactions. This is because any immune response to foods has the potential to drive inflammation and affect the immune system's fine balance.

Environmental sensitivities to perfumes, chemicals or high exposure to pollution, plastics, and chemicals can be an indication of low-level detoxification, which could also lead to inflammation.

Since inflammation and a well-balanced immune response are at the core of optimal fertility, removing as many chemicals as possible, including plastics, and supporting the liver but avoiding a full-on detox (unless absolutely necessary as it can increase the burden on the immune system) is a first step towards improving the chances of a successful pregnancy.

The Balance of Inflammation at Implantation & the First Trimester

The importance of the role of the immune system in fertility is of upmost importance during implantation. Implantation is a pro-inflammatory state, caused by the blastocyst penetrating the epithelial lining of the uterus and damaging the endometrial tissue.

Additionally, the adaptation of the maternal blood vessels to secure an appropriate blood supply from the placenta to foetus triggers a further inflammatory response. This inflammatory response promotes the recruitment of immune cells to the area of which 70% are uterine NK cells, which play an important role in the development of the endometrium, resulting in maternal immune tolerance once the embryo has been implanted, hence the importance of NK cell studies in cases of recurrent miscarriage or unexplained infertility.

From the second trimester, the immune cells present in the uterus switch from a pro inflammatory environment (T-helper cells 1 or TH1) to an anti-inflammatory one (T-helper cells 2 or TH2), until inflammation is switched on again as labour starts.

NK cells play a key role in modulating TH1 and TH2 balance, so when reviewing a NK cell study, we look for a balance between pro- and anti-inflammatory cytokines. Switching from pro to anti-inflammatory states in the uterus throughout pregnancy means that an imbalance in each of the immune system expression could result in failure to implants or miscarriage.

Nutrition to Modulate Inflammation in Support of Implantation

From a nutritional perspective, the aim in cases of previous miscarriages or immune dysregulation is to support a balanced, immune system, including the necessary nutrients, but also avoiding any foods or environmental factors that could trigger an inflammatory cascade.

My fertility support diet for women who have autoimmune conditions is based on a modified Mediterranean diet to provide nutrients needed to support immunity and a healthy pregnancy.

My approach varies person to person, as no two people’s illness is the same, even if their diagnosis is identical. Recognising that everyone’s body, biochemistry and history is unique, is an important part of creating an intervention that really works. I work with the person with the condition, not just the condition itself.

However, here are some examples of the micronutrients we want to increase:

• Vitamin C which supports natural killer activity

• Vitamin E which is a powerful anti-inflammatory

• Vitamin D that supports natural killer maturation

• Zinc and selenium that support immunity

• Omega 3 fatty acids which help immunity and reduce inflammation

• Curcumin and ginger (food sources) because of the anti-inflammatory properties.

• Quercetin and bromelain (food sources like apples, onions, pineapple) because they can help balance the immune system supporting inflammation depending on the phase of conception

Final Words

Every body is biochemically different and the mechanisms of action underlying each case will vary person to person. Nonetheless, inflammation and autoimmunity can both have a significant impact on female fertility. By understanding the underlying mechanisms of these conditions and their effects on the reproductive system, we can provide targeted dietary and supplement recommendations to support the fertility of individuals with such conditions. By taking a holistic approach to fertility, nutritional therapy can help people with inflammation and autoimmune conditions to optimise their chances of conceiving and having a healthy pregnancy.

NB: Please consult with a medical practitioner before starting any new dietary protocol or supplementation plan.

Next Steps

Hi I'm Molly, I'm a UK-based Nutritional Therapist (DipION, mBANT, CNHC) and Self-Compassion Coach (MSc) serving my community in Harpenden and online. Here in my little online home, you'll discover the benefits of nutritional therapy and complementary therapies for autoimmune disease and chronic illness.

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