What is immune infertility? Gynecologists are here to answer!

There are many reasons that lead to female infertility. For example, some people become infertile due to immune factors. This is medically called immune infertility. Below, please see the expert’s introduction to the relevant knowledge and treatment of this disease.

1. What is immune infertility?

Immune infertility is a common type of female infertility. It generally refers to the patient's normal ovulation and reproductive tract function, no pathogenic factors are found, and routine examination of the spouse's semen is within the normal range, but there is evidence of anti-fertility immunity, resulting in infertility. There are many types of this disease, but most are caused by autoimmunity or alloimmunity to reproductive system antigens. Reproductive system antigens such as sperm, seminal plasma, zona pellucida and ovaries can produce autoimmunity or alloimmunity under certain circumstances, generating corresponding antibodies that hinder the combination of sperm and egg and lead to infertility. The production of anti-sperm antibodies is one of the common ones. Sperm, as a unique antigen, produces anti-sperm antibodies after coming into contact with the body's immune system. The reasons why men and women produce anti-sperm antibodies are different.

2. Treatment Methods

1. Isolation therapy

Using a condom every time you have sex can prevent sperm antigens from further stimulating the woman. After a few months, the infertile couple can remove the condom and have sexual intercourse, or undergo artificial insemination. However, this method cannot improve the pregnancy rate and can only be used as an auxiliary treatment.

2. Immunosuppressive therapy

Adrenal cortical hormones have anti-inflammatory effects, interfere with the processing of antigens by macrophages, and reduce the cytotoxic effect of complement on sperm. Commonly used methods include low-dose continuous therapy, high-dose intermittent therapy and local vaginal medication. Commonly used drugs are prednisone, dexamethasone and methylprednisolone. Some scholars have reported that prednisolone can reduce the level of serum antisperm antibodies and increase the chance of pregnancy. However, a randomized, double-blind, prospective study conducted by some scholars showed that immunotherapy did not improve fertility. Large doses of medication have significant side effects and are difficult for infertile couples to accept.

3. Intrauterine insemination

When anti-sperm antibodies exist in the cervical mucus of an infertile woman, interfering with fertility, her husband's semen can be processed in vitro to separate high-quality sperm for intrauterine artificial insemination. It avoids the restrictive effect of anti-sperm antibodies in cervical mucus on sperm passage. It is reported that about 15% of patients become pregnant after multiple cycles of IUI.

4. Semen processing to remove anti-sperm antibodies

Sperm washing therapy to remove antibodies from the sperm surface is not successful because of the high affinity of antibody-antigen. Placing sperm in low pH or high zinc ion solutions to dissociate antibodies will cause irreversible loss of sperm motility. Placing sperm in a solution with a high serum concentration can reduce detectable antisperm antibodies (MAR method), and the antibodies reappear when the sperm are resuspended in serum-free culture medium. This semen manipulation does not improve pregnancy rates. The sperm bound to the anti-sperm antibodies were incubated with the frozen-thawed membrane fragments not bound to the anti-sperm antibodies to absorb the anti-sperm antibodies. But this approach resulted in fewer viable sperm being retrieved.

3. Treatment principles

1. Treatment of the cause. Protect the blood-testis barrier function and reduce autoimmune response. Anti-inflammatory treatment of testicular, epididymal and accessory gland inflammation can reduce antibody titers;

Surgical removal of unilateral diseased testicles, epididymis or to clear obstructed ducts.

2. Reduce antibody titer and improve fertility. For women with sperm agglutination antibodies in their bodies, men should use condoms during sexual intercourse to avoid contact with semen. After 6 to 18 months, the antibody titer of 40% to 60% of women has decreased, and conception can be achieved through sexual intercourse during ovulation. Immunosuppressive therapy can also be used under the guidance of a doctor. Men can use testosterone to inhibit sperm production and reduce antibody titers, but this only has a temporary effect. They should try to conceive when spermatogenesis is restored after stopping the drug and antibodies are still at a low level.

3. Traditional Chinese medicine has a good therapeutic effect. It has been reported that the use of methods such as clearing away heat and detoxifying, promoting blood circulation and removing blood stasis, or nourishing yin and reducing fire can achieve very good results, but the basic principle should be to differentiate and treat based on syndrome, so that the effect will be better.

4. Perform artificial insemination. In short, immune infertility can be prevented to a certain extent, including early correction of developmental abnormalities, active treatment of reproductive tract infections, prevention of reproductive tract damage, and attention to menstrual hygiene, etc.