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.
