Question

Part II - Getting the Diagnosis Right "I don't understand," Jane said looking at Dr. Klein. "What does my immune system have to do with my infertility issues?" "Infertility can unfortunately be a complication of several autoimmune diseases. Given your history of gastrointestinal issues along with the presence of several specific autoantibodies I believe you may have Celiac Disease. I would like you to see a gastroenterologist to confirm the diagnosis," Dr. Klein explained. Brian interrupted, "But I thought Jane has irritable bowel syndrome? Did the IBS cause the Celiac Disease?" "No, I fear that Jane may have been misdiagnosed with IBS when all along she had Celiac Disease. The two can have similar symptoms, but there are tests that can definitively identify Celiac Disease," Dr. Klein explained. "If I get treated for Celiac Disease, will I be able to have a baby?" Jane asked fearfully. Dr. Klein patted Jane's hand, "Let's get the test results back and make sure we understand the cause of your intestinal issues, and then we'll concentrate on your infertility. "I don't think I understand," Jane said looking from Brian to Dr. Klein. "You explained to us what an antibody is and I thought they were good, so why would they cause disease? I don't know how I could have gotten an autoimmune disease in the first place. I'm pretty healthy. I exercise and try to eat right. What could I have done differently?"

Answer 1

The risk factors associated with autoimmune diseases are:

• The disease may be caused by conditions like Epstein-Barr virus which occurs in more than 90% of the population.
• There may be a family history of autoimmune diseases which can also become a risk factor.
• Women are at a higher risk of developing an autoimmune disease which seems to be because of the enhanced immune system in them.
• Ethnicity is also associated with autoimmune disease. For example,  African Americans, American Indians are at a higher risk of attracting autoimmune diseases.

The exact causes of autoimmune disease are still being speculative and are under studies. But Jane could have adopted some healthy habits of hygiene, visiting doctor regularly and avoiding people with infections.

The hygiene hypothesis is often used to trigger the onset of autoimmune diseases. The hygiene hypothesis is based upon the epidemiological data, particularly migration studies, showing that subjects migrating from a low-incidence to a high-incidence country acquire the immune disorders with a high incidence at the first generation.