Reproductive immunology

The immune system (immune system) protects our body from attack by pathogens and from harmful effects of other agents. Sometimes, however, it ceases to do its job and instead of being our protector, it turns against us. A malfunctioning immune system disrupts the entire body and can cause immune infertility. A woman’s body can then produce antibodies that will either attack her own egg cells or fight her partner’s sperm, thus preventing fertilization. The body of a man suffering from immune infertility, on the other hand, can produce antibodies that will destroy the genetic material of sperm, also thus leading to infertility.

Despite immune infertility, fertilization is possible. The immune system does not always prevent the sperm from fusing with the egg cell. However, the resulting embryo contains the genetic material of the mother and father, so in the uterus it can be taken as an intruder. In such a situation, the woman’s body begins to fight it off and a miscarriage occurs. Immune disorders can impair both the process of fertilization, implantation of the already fertilized fetal egg and lead to habitual miscarriages. Immune disorders are estimated to account for about 65%-70% of pregnancy loss in women with habitual miscarriages. Both autoimmune and alloimmune factors play their part.

Immune infertility is a disorder that occurs only during a lifetime. This means that a couple may not have had any problems getting pregnant for the first time, while difficulties may already arise with the second pregnancy.

Therefore, all couples who:
– already have a diagnosis of infertility
– have experienced habitual miscarriages
– often face inflammatory conditionsshould visit the immunology clinic

Immune infertility is a rather complex problem. Many different disorders can interfere with the immune system and indirectly cause immune infertility. So there are quite a few tests that need to be performed.

The most important immunological tests performed at Gyncentrum Clinic are:

• Immunophenotype from peripheral blood – it determines the number and proportion of individual lymphocytes in the blood
• Congenital hypercoagulability Gene F2, F5 (Factor V Leiden + 20210 G-A mutation of prothrombin gene met. PCR) – this is a test for genetic susceptibility to blood clots (congenital thrombophilia). It is a common cause of immune infertility and miscarriages.
• MTHFR thermolabile variant (MTHFR 1298C polymorphological variant determination + MTHFR C 677T thermolabile variant determination) – this is a genetic test for mutations in the MTHFR gene. These can cause, among other things, hypercoagulability and impaired folic acid metabolism.
• Hypercoagulability package (congenital hypercoagulability Gene F2, F5 (factor V Leiden + 20210 G-A prothrombin gene mutation met. PCR) + thermolabile MTHFR variant) – this package combines testing for congenital thrombophilia and MTHFR gene testing
• Testing for the APA 1 polymorphism in the IGF 2 gene – this is a test for men only. The presence of this polyformism increases the risk of miscarriage.
• Mutation in the CFTR gene (290 mutations) male infertility (PCR method) – these mutations contribute to the development of cystic fibrosis and male infertility.
• Y-chromosome microdeletions – this is a genetic test to see if Y-chromosome deletions are the cause of impaired male semen quality.
• Azoospermia (PCR method) – this test checks whether a man suffers from azoospermia, which is a lack of sperm in semen.
• Mutation 20210 G-A of the prothrombin gene (met. PCR) – this is a genetic test for a gene that may contribute to hypercoagulability.
• Factor V Leiden (met. PCR) – also a tool for diagnosing predisposition to thrombosis.
• Cystic fibrosis 205 mutations (met. PCR) – this involves checking whether a patient has cystic fibrosis. It is a systemic disease that manifests itself mainly through chronic bronchopulmonary disease.
• Lupus anticoagulant, anticardiolipin antibodies (IgG, IgM), antibodies to β2 -glycoprotein I (IgG, IgM), antibodies to phosphatidylserine (IgG, IgM), antibodies to phosphatidylinositol (IgG, IgM), prothrombin antibodies (IgG, IgM) – these analyses are performed to detect antiphospholipid syndrome, which can lead to immune infertility and recurrent miscarriages.
• The presence of blocking antibodies (allo MLR) – the absence or deficiency of these antibodies leads to the treatment of the embryo as an intruder. As a result, the immune system begins to fight it, and the pregnancy cannot develop.
• Microcytotoxic test – this is a test to see if there are antibodies in a woman’s blood that fight her partner’s lymphocytes. A positive result of the analysis means that they are likely to start fighting the embryo as well.
• KIR – this analyzes the activity of receptors found on the surface of immune cells in the uterus.
• Molecular tissue typing (HLA C) – this checks the expression of HLA-C tissue compatibility antigens. Among other things, it determines whether an embryo is considered a potential danger in the uterus.
• Homocysteine – this is performed to determine the risk of thrombotic diseases
• ANA1, ANA2, ANA3 – these three tests check whether ANA antibodies are present in the patient’s body. Their presence indicates an ongoing autoimmune process. In healthy individuals, the test will show nothing.
• Antinuclear antibodies type of luminescence – the test analyzes the type of luminescence and titer of ANA antibodies. This allows better diagnosis and monitoring of autoimmune diseases.
• Inhibin B – this is a protein hormone that has a huge impact on fertility in men and women. Determination of its concentration can therefore be very helpful in the diagnosis of immune infertility.
• Karyotype (cytogenetic test from peripheral blood) – is a genetic test that checks the patient’s set of chromosomes for their number, structure or size. Chromosome abnormalities can affect the entire body, including the immune system. This can translate into immune infertility.

Once the diagnosis of immune infertility is completed, we can begin treatment. Most often, it consists of taking preparations that alter the activity of the immune system, which are administered in the form of intravenous infusions. Couples with immune infertility are also advised to use assisted reproductive methods. One of these is insemination. It involves the introduction of pre-prepared sperm into the uterine cavity. We can undergo insemination several times. However, if it does not bring the expected results, it is worth going a step further and using in vitro fertilization. Thanks to it, we may be able to welcome a beautiful baby boy into the world. During treatment, we recommend not to stop natural efforts to have a child. Many couples, despite immunological infertility, manage to get pregnant naturally.