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Immune Dysfunction And Infertility

Our immune system is responsible for fighting against bacteria and viruses by production of antibodies . Autoimmunity or immune dysfunction is an inappropriate immune response where your body produces antibodies against your own cells. This may cause infertility if the antibodies are against gametes ( eggs  or sperms).

Around 10-15 % of infertile couples are labelled to be of unexplained category where no obvious cause of  infertility can be detected . Such couples  probably belong  to the  immunologic group where certain antibodies or immune system may be the culprit and causing infertility . Immune infertility reproductive disorder affects both men and women causing their immune system to wage war on sperm .

Clinical effects or mechanism of  infertility due to antibodies  in men / women.

  • Interference with sperm production
  • Poor sperm survival .
  • Reduce sperm motility.
  • Interference with sperm activation for fertilization .
  • Interference with sperm zona pellucida binding and or penetration .
  • Inhibition of fertilization , cleavage, embryo development and implantation process .
  • Miscarriages

When does one need immunological fertility testing.

  • History of repeated miscarriages .
  • History of repeated IUI/IVF failures.
  • Unexplained infertility .
  • Pre –existing immunological disorder or autoimmune diseases like thyroid, diabetes
  • Endometriosis .
  • Poor eggs production in stimulated cycle.

Some tests to detect immunological dysfunction causing infertility include:

  • Natural killer cells activity
  • TH 1 /TH2 Intracellular cytokin ratio
  • Antisperm antibodies (male and female)
  • ANA, APA, Anti – DNA
  • Thrombophilia
  • Anti thyroglobulin antibody
  • Anti ovarian antibody
  • CD 57 cells within endometrium

Majority of  immunologic infertility cases are (upto  20%) due to antisperm antibodies (ASA) which prevents fertilization .  ASA  may be  present in men ( mostly resulting from trauma ) resulting in clumping of sperms or may   also be  seen in women resulting in killing of sperms .

Following factors/ conditions may cause development of ASA, hence require testing for ASA .

  • Testicular trauma orchitis .
  • Genitourinary tract infection .
  • Vasectomy/ Vasovasostomy.
  • Spinal cord injury .
  • Homosexuality , multiple sexual partners.
  • Testicular cancer.

There is no clearly defined treatment for immunological infertility. Some treatment may include immune suppressive therapy, intra uterine lipid infusion etc. Historically the best results seem to follow a trial of ovulation induction and insemination followed by In vitro fertilization ( IVF)  with sperm washing or ICSI ( a process that involves injecting a washed and processed sperm directly into an egg). IVF or ICSI may be combined with immunosuppressive agents for better outcomes.