Treatment of immunological infertility

Apr 15, 2012 , Veronika Fejfarová

lecba-imunologickych-poruch-neplodnosti.jpg - kopie
lecba-imunologickych-poruch-neplodnosti.jpg - kopie
Treatment of immunological infertility is a process in which doctors try to make the woman's body to not refuse the sperms of partner, or embryonal cells and cells of the embryonal sack. Impairment of the immunological barrier around the testicles is another situation in which is necessary the treatment of immunological infertility. In this problem the man's body attacks its own sperms. These situations are nowadays treated primarily by administration of immunosuppressive drugs or methods of assisted reproduction.

Treatment of immunological infertility

Infertility can be described as the inability to conceive a child during regular unprotected sexual intercourse which lasts more than a year. Several important events are essential for successful conception. Mature female egg must be released from the ovary, caught in fallopian tube and fertilized by male sperm. Afterwards, the fertilized egg must descent into the uterus in which is it nidated and begins to develop. If there is a problem in one or more parts of this process, it results in infertility. Treatment of immunological infertility is quite complicated and challenging, but in most cases can be infertility solved by methods of assisted reproduction.

Immune system

Immune system is composed of many cells and protects us everyday from external adverse influences. Unfortunately, sometimes from unknown reasons, the immune system attacks also against particles or cells which it should not have normally. For example, during the excessive activation of immune system due to frequent gynaecological inflammations, the immune cells in lining of cervix uteri learn to recognize sperms as foreign, potentially harmful particles and destroy them. This is how disorders of fertility develop. The antibodies can be formed against both sperms and covering of the eggs, embryo or fetal cells. As consequence immunological infertility or abortion develops.

Examination of immunological infertility

Male fertility depends mainly on the quality of semen. Therefore, a reliable diagnostic method for infertility is sperm count. It is a microscopic analysis of ejaculate which was obtained by masturbation, usually after 2-3 days of sexual abstinence. In this test is assessed amount of sperms, their quality, movement speed and shape. Furthermore, examination technique that assesses antibodies of sperms consisting from blood or seminal plasma, i.e. fluid of ejaculate in which are living sperms, is used. In women with immunologic infertility is performed an examination of cervical mucus and blood to detect antibodies.

Treatment of immunologic infertility in men

Immunological infertility in men may be caused by impairment of  the barrier that separates the testicles from the immune system. This may occur, for example, due to injury, inflammation or testicular cancer. Cells of the immune system come into conflict with the tissues which they had not known and start to attack them as foreign. Antibodies against body's own sperms are formed. Afterwards, these antibodies "mark" sperms, change their concentration, motility and shape, and thus sperms are not able to pass through the mucus in the cervix uteri, or to reach the egg and fertilize it. Another possibility is that the male semen does not contain any substances which dampen the immune system of women so it can not attack sperms, and make it possible for them to pass freely through mucus of the cervix uteri and fertilize the egg. In the treatment of immunologic infertility were previously used methods in which were sperms purified from antibodies. But nowadays, the immune system of man is rather suppressed for certain time until the partner is fertilized. Accordingly, special medication called corticosteroids is used, its function is to regulate immune system. In addition, some experts in the treatment of immunological infertility recommend protected sexual intercourse for at least three months, if antibodies against sperms are formed by the woman. By that time, immune cells should “forget”  that sperms are dangerous for the body. However, this method is in most cases not effective.

Treatment of immunologic infertility in women

Sperms behave in the woman bode as foreign cells. However, under normal circumstances, the production of antibodies against sperms does not occur. This is caused by the substances contained in semen which dampen the immune system, and thus they prevent the development of women's sensibility to sperms after sexual intercourse. In hypersensitive gynaecological tract of the women, i.e. repeating local inflammations, or the absence of suppressing substances in semen, are antibodies against sperms formed in the cervical lining. These antibodies either immobilize sperms or impair their structure, preventing them from penetrating into the egg, i.e. fertilization. In this causation of immunologic infertility, it is accessed to the local therapy of cervix uteri in which are corticosteroids applied. Otherwise, overall administration of corticosteroids is used, so-called general immunosuppression, which regulates the function of immune system.

In women, the reaction of immune system might not be directed only against foreign sperms. Similarly to men, may be formed antibodies against the body's own cells and organs. If the woman produce antibodies that react with the covering of eggs and prevent sperms from penetration, it is possible to use immunosuppressive therapy in which is inhibited the activity of immune system. Otherwise, methods of assisted reproduction are considered. Also, the immunosuppressive therapy is used in the case when are antibodies against fetal or embryonic tissues produced. But accordingly, methods of assisted reproduction can not be performed because they are not usable solution for this problem. For treatment of the autoimmune disease called systemic lupus erythematosus, i.e. disease in which is by female body formed a large number of different antibodies against sperms, eggs, embryo or placental blood vessels, we use corticosteroids or immunoglobulins in specialized cases. These substances bind to the antibodies which are then unable to respond. If antibodies against placental blood vessels are formed, a specific treatment can be also applied. Antibodies bind to the vessels and their effect results in vascular blockage, and therefore blood can not flow through these impaired vessels. This situation can be solved by dilution of mother's blood, for example, by low doses of aspirin. These substances also help to lyse existing clots.

Methods of assisted reproduction

Not only in the treatment of immunological infertility are successfully used methods of assisted reproduction. These include artificial insemination, in vitro fertilization and intracytoplasmic injection. In intrauterine insemination (IUI) are taken sperms injected directly into the woman's uterus and they may not overcome the obstacle of cervical mucus with antibodies. In vitro fertilization (IVF) is the method in which are harvested sperms injected into the pre-collected egg, the egg is then fertilized and returned into the uterus. In intracytoplasmic injection (ICSI) is injected only one healthy sperm in to the egg which was taken in advance. Fertilized egg is then also returned into the woman's uterus.

Specialized treatment of immunological infertility

Clinical immunologists have access to other drugs, such as hormones that can affect the function of immune system, or substances that directly interfere with the specific reactions of immune system. However, this is a very specialized treatment and can be performed only by the experts. Firstly, it is necessary to make a special examination in which are determined different kinds of antibodies, in order to design the best treatment.

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