Autoimmune Factors in Fertility

Immune therapy involves treatment of immunological dysfunction, which can affect embryo implantation and pregnancy outcome. Treatment options involve certain medications, as well as Intralipid therapy and intravenous immunoglobulin (IVIG).

 

How does the immune system work?

The body’s immune system defends the body from pathogens and intruders. When a woman has an autoimmune disease, her body attacks its own healthy cells. The main components of the immune system are the white blood cells (WBCs), which kill invading organisms. When the body produces antibodies, they work with T-cells to destroy targeted intruders.

 

How can autoimmune diseases affect a person’s fertility?

A woman with an autoimmune disease has a difficult time with pregnancy. The body attacks developing fetal cells, believing these to be foreign substances. What makes these conditions worse is that certain medications used to treat autoimmune disease are associated with frequent miscarriage.

 

What is corticosteroid therapy?

Corticosteroids include dexamethasone, prednisone, and prednisolone. These drugs are routinely prescribed in many in vitro fertilization (IVF) and assisted reproductive technology (ART) programs. Steroids are prescribed within ten days of initiation of ovary stimulation with gonadotropins, and the woman must continue to take them until pregnancy is confirmed. When a negative test results, the dosages is tapered over a 7-10 day period. If the woman becomes pregnant, the steroid is taken up to 7-8 weeks of gestation.

 

How can blood-thinning agents help?

When a woman suffers from recurrent pregnancy loss (RPL), the fertility specialist may prescribe blood thinners, such as heparin or baby aspirin. This works well for patients with antiphospholipid syndrome, which is a complicated thrombophilac condition. These medications are started after the first positive pregnancy test, and the woman must take them for three months. Depending on the severity of the condition, the drugs may be taken throughout the pregnancy.

 

How does intravenous immunoglobulin work?

IVIG is a form of super-concentrated immunoglobulin G (IgG), which is derived from human plasma (blood component). IgG modulates immunologic function at the time of embryo implantation in the uterus. It works by suppressing activated natural killer cells (NKa), suppressing B cells to prevent antibody product, reducing T-cell activity, and warding off toxic antigens. IVIG is given seven days before embryo transfer, and then again when pregnancy is confirmed.

 

What is intralipid treatment?

A solution often used for parenteral nutrition is Intralipid. This drug suppresses NKa in various culture systems, and improves pregnancy outcome.

 

Which autoimmune diseases impact fertility?

Infertility is characterized by no pregnancy after a full year of unprotected sex. Recurrent pregnancy loss (RPL) is defined as 2-3 miscarriages in a row. Approximately 80 autoimmune disease that can affect both male and female fertility. These include:

  • Anti-phospholipid syndrome
  • Type 1 diabetes mellitus
  • Systemic lupus erythematosus (SLE)
  • Scleroderma
  • Rheumatoid arthritis (RA)
  • Elevated anti-nuclear antibody (ANA)
  • Sjorgen’s syndrome
  • Hashimoto’s thyroiditis

 

What tests can the fertility specialist do to detect immune problems?

An antisperm antibody test is used to detect certain antibodies made by a male’s immune system. Around 33% of infertility cases occur as a result of problems with male fertility. These include problems associates with sperm count, sperm mobility, and sperm delivery. Another test done by the doctor is to check for natural killer cells, as these attack the developing embryo. This test is done through a biopsy (tissue sample) of the uterus lining.