In addition to starring in Daisy Jones and the Six, Riley Keough quietly welcomed her first child in 2022. The news of Keough’s daughter’s birth surprised most people, as Keough and her husband have been private about their path to parenthood. But in a recent interview Keough shared details including her daughter’s name, the fact that she welcomed her via surrogacy, and the factors that led her to make this decision.

“I think it’s a very cool, selfless, and incredible act that these women do to help other people. I can carry children, but it felt like the best choice for what I had going on physically with the autoimmune stuff.” Keough tells Vanity Fair

woman in the doctor's office

While Keough, who also shared that she has Lyme disease in the interview, didn’t reveal many details about her fertility journey, a lot of people may relate to her statement. As we’ve previously reported, autoimmune conditions are on the rise among women, yet these conditions are frustratingly misunderstood. 

Autoimmune conditions span a wide range of issues and presentations, but one trait they all share is that the body’s defense systems begin to attack normal cells, as the body is unable to properly identify foreign cells, according to Johns Hopkins Medicine. There are some symptoms that characterize autoimmune conditions — think fatigue, joint pain, and recurring fever. But, because the symptoms can be common ailments and there’s no singular test for many of these conditions, autoimmune diseases can be tough to diagnose.

How do autoimmune conditions affect fertility and pregnancy?

The effect this type of condition can have on the body’s ability to conceive and carry a pregnancy has not been perfectly established by the medical community. Some research suggests that pregnancy may cause autoimmune symptoms to improve…but, it may also cause them to worsen. 

couple making a decision

Of course, that’s a significant gamble to take, especially for people who experience debilitating symptoms thanks to their autoimmune conditions. The idea that these diseases could flare up during or after pregnancy is terrifying. And while surrogacy was the right option for Keough, offering a way to circumvent this possibility, not everyone has that option. While it’s important that we challenge the misconception that surrogacy is exclusively a “celebrity thing”, it’s also crucial that we point out that surrogacy, in many cases, requires a lot of privilege. For a lot of people who deal with autoimmune issues, this won’t be an option — that’s why it’s so vital that we learn more about how exactly autoimmune issues affect pregnancy, and vice versa.

For Rescripted’s co-founder, Kristyn Hodgdon, this need for more information (and more awareness of the relationship between autoimmune and reproductive issues) is personal. Hodgdon suspects her own experience with an autoimmune condition may be a factor in why none of her embryo transfers have taken, yet she hasn’t found a doctor practicing Western medicine who is willing to explore that possibility.

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“There’s not enough research on how autoimmune diseases can impact fertility. As a fertility patient, you’re told that as long as your condition is managed with medication and your levels look fine on paper, then it shouldn’t affect conception — but antibody levels are rarely looked at (at least in the case of Hashimoto’s). It just seems counterintuitive to me, since having an autoimmune disease literally means that your body is attacking itself,” she says. “Also, in my experience, there’s a big disconnect between traditional and holistic medicine when it comes to eating for autoimmune health. Should you eat gluten, or not? It’s really difficult to know what to do that will actually make a difference for your fertility and overall health.”

woman eating a croissant

As of right now, the link between autoimmune health and pregnancy/ fertility is frustratingly unclear. That’s why, even though people love to criticize celebrities for pursuing surrogacy (note: this is never acceptable — we are not in the business of judging anyone else’s reproductive choices), we applaud Keough for doing what’s best for her body, taking the choice into her own hands, and making the decision that sat right with her. As she says, surrogacy is an incredible thing that gives many families the opportunity to expand when the prospect of pregnancy and what it can do to your health feels scary and unpredictable.

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.