Lupus doesn’t cause infertility directly. But indirect factors may affect your ability to become pregnant or impregnate someone else.

Lupus is an inflammatory autoimmune disease that occurs when the body’s immune system mistakenly attacks its own tissues.

The disease can indirectly affect fertility through various factors, such as:

  • sex and reproductive organs
  • certain antibody levels
  • current lupus activity
  • medications and treatment
  • other opportunistic infection(s) or conditions present

People who have lupus are more likely to have an abnormal menstrual cycle than the general population, says Isabelle Amigues, MD, a rheumatology specialist with UnabridgedMD.

These irregularities may be caused by lupus activity — for instance, systemic inflammation — or medications used to treat the disease, explains Himali Maniar Patel, OB-GYN at Nisha Women’s Hospital and IVF Centre in Ahmedabad, India.

Your menstrual cycle influences when you ovulate or release an egg from the ovary into your fallopian tube.

If you don’t ovulate on a predictable schedule, it can make working with or around your fertile window difficult. And if you don’t ovulate at all, pregnancy isn’t possible.

A small 2021 study suggested that people with lupus may have lower ovarian reserves (fewer eggs). This can negatively affect overall fertility.

The autoimmune activity of lupus, as well as some lupus medications, can also increase the risk of premature ovarian insufficiency (POI).

“[This] is when your ovaries stop releasing eggs, and you stop having periods before the age of 40, which can make it harder to conceive,” says Patel.

People with lupus may also have increased levels of certain antibodies known to affect pregnancy.

Anti-corpus luteum antibodies, for example, attack and destroy the corpus luteum, which is a structure that develops in the ovary after it releases an egg.

“The corpus luteum secretes a hormone that causes the uterus to thicken and prepare for the implantation of a fertilized egg,” explains Patel.

So, if the corpus luteum experiences damage, an egg may be unable to implant in the uterus.

Anti-oocyte antibodies can also attack and destroy oocytes, which are cells in the ovaries that develop into eggs.

“If the oocytes are damaged, you may have fewer eggs available for fertilization,” says Patel.

Inflammation caused by lupus may affect the overall quality or quantity of your sperm, according to Patel.

Disease activity may also damage the testicles, affecting your sperm as a result.

Some people with lupus may experience an increased risk of erectile dysfunction (ED) or difficulty developing or maintaining an erection that’s firm enough for penetration.

“Here, erectile dysfunction can be caused by vascular problems, nerve damage, or psychological stress from lupus or by some lupus medications,” says Patel.

If the penis isn’t hard enough to enter the body to “deliver” the sperm, the sperm won’t be able to meet and fertilize an egg.

A small study from 2000 suggested that males with lupus have atypical levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which support testicular testosterone production.

A 2020 study found a link between FSH and LH imbalances and male infertility.

“People with lupus are more likely to have conditions that are associated with infertility than people without lupus,” says Patel.

These conditions include:

  • Antiphospholipid syndrome: It increases blood clot risk, which can result in miscarriage, stillbirth, preterm delivery, and preeclampsia.
  • Hashimoto thyroiditis: This condition causes your immune system to attack your thyroid gland, interfering with the production of certain hormones. Hormonal changes can affect the menstrual cycle or sperm production.
  • Lupus nephritis: It causes your immune system to attack your kidneys, interfering with essential hormone production and affecting sexual function. Its treatment, hemodialysis, can also affect fertility.
  • Klinefelter syndrome: This condition occurs when someone is born with one or more extra X chromosomes, causing their cells to have XXY chromosomes. This can affect your ability to produce sperm.

Cyclophosphamide (Cytoxan) is an immunosuppressant medication often used to treat severe lupus.

Patel says that — depending on your anatomy — cyclophosphamide can diminish ovarian reserves and cause POI or reduce sperm quality and quantity by damaging the reproductive cells.

“The exact risk of infertility depends on the dose and duration of treatment, as well as your age and sex,” she says. These side effects may not always be reversible.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, Aleve, and Motrin can also have an impact.

“NSAIDs may cause ED by negatively affecting the blood flow to the penis,” explains Patel.

“They can also interfere with ovulation and implantation by inhibiting the production of prostaglandins, which are substances that regulate the menstrual cycle and pregnancy,” she says.

Does lupus increase the risk of miscarriage or stillbirth?

People with lupus have a higher risk of miscarriage and stillbirth than the general population, according to Amigues.

Certain co-occurring conditions can also increase your risk. These include:

Is pregnancy safe if you have lupus?

“With proper management and monitoring, many people with lupus are able to have successful pregnancies,” says Patel.

Waiting at least 6 months since your last flare-up to become pregnant can help reduce the risk of complications.

Can lupus affect a developing fetus during pregnancy?

Patel says that, in rare cases, antibodies from your immune system may cross the placenta and cause complications.

“But this can be managed with proper medical care,” she adds.

Lupus doesn’t cause infertility. However, some co-occurring conditions and medications used to treat lupus can negatively affect your overall fertility.

If you have lupus and have questions about your ability to conceive, consult a rheumatologist or fertility specialist.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.