At 28, can IVF worsen my alpha-1 antitrypsin deficiency?

Question

Hello, Doctor,

I am a 28-year-old woman recently diagnosed with alpha-1 antitrypsin deficiency. I have been experiencing shortness of breath and fatigue, and I am really worried about how this condition will affect my plans for pregnancy. I am concenered whether this deficiency can be passed down to my children. We also heard that certain medications and even birth control pills can put more strain on the liver. Please tell me,

Could pregnancy worsen my lung and liver complications, or is it generally safe if managed properly?
Would IVF or hormonal treatments for fertility trigger worsening of my condition?
Should I avoid hormonal contraception and switch to a copper IUD instead?
Should I undergo genetic counseling before trying to conceive?
Does menopause impact the progression of alpha-1 antitrypsin deficiency, since estrogen has some role in lung health?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Alpha 1 antitrypsin deficiency (AATD) affects your pregnancy and fertility in different ways,

Pregnancy can be safe in women with mild or well-controlled AATD, but it requires careful multidisciplinary management t. During pregnancy, oxygen demand naturally increases, which may worsen breathlessness and respiratory symptoms. Continuous monitoring throughout pregnancy is therefore very important.

IVF treatment protocols often involve estrogen stimulation, which can temporarily increase liver workload. This is particularly relevant in women with AATD who already have liver involvement or abnormal liver function.

Estrogen containing contraceptive pills, patches, or vaginal rings are generally best avoided in women with liver abnormalities because estrogen is metabolized through the liver. In many cases, a copper intra-uterine device (IUD) is considered one of the safest and most suitable contraceptive options.

AATD is an inherited disease. The risk to children depends on both partners’ genotypes. If the partner has a normal genotype, such as PiMM, the child may become a carrier but is usually unaffected. If the partner is a carrier, such as PiMZ, the child could inherit the condition. If the partner has a severe deficiency such as PiZZ, the risk becomes significantly higher. Because of this, genetic counseling and partner testing are strongly recommended before conception.

I hope this information helps you.

Feel free to ask further queries.

Thank you.