IMMUNOLOGICAL CAUSES OF INFERTILITY PART 2

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Infertility as we know and has been defined severally, is the inability of a couple to achieve clinical pregnancy after having constant, timely, unprotected sex for one year or more. It could be primary or secondary, it’s primary when the couple has not conceived before and secondary when the couple have conceived before but are no longer able to. Its affects men and women equally and the main symptom is the inability to get pregnant. Some of the causes of infertility include, age, lifestyle, environmental and occupational factors, excessive exercise, eating disorder, overweight or obesity, poor diet, genetic factors, some medications and therapies, pelvic inflammatory disease (PID), endometriosis, ovulation disorder, sexually transmitted infections ( STI), low sperm count, poor motility of sperm, abnormal sperm morphology, hormonal imbalance, abnormalities in the immune system (immunological factors).

ABNORMALITIES IN THE IMMUNE SYSTEMTHAT CAN CAUSE INFERTILITY (IMMUNOLOGICAL INFERTILITY)

The immune system is responsible for fighting foreign bodies in the body through the production of antibodies and so when the system can no longer differentiate a “good” foreign body from a “bad” one then there is a problem. Immune infertility is a reproductive disorder that affects men and women and thus causes their immune system to wage war on sperm. Women who have been diagnosed of immune infertility usually produce Antisperm Antibodies (ASA) in their reproductive systems. These antibodies act by neutralizing sperm by clumping them together and creating holes in their membranes and thus affect their physical morphology. They also coat over receptors that are involved in sperm-egg binding and fertilization process.

Sperm antibodies may also occur in either male or female partner and can be detected in the blood and/or sexual secretion through agglutination or immobilization using immunobeads. The test can also be done by examination of the ejaculate in the post coital test; this would help to get some clues on the interactions that exist between spermatozoa and female genital secretions. Sperm antibodies can cause infertility by disrupting sperm motility or the binding of the egg. They are also present in female sexual secretion which may trap spermatozoa and stop them from moving through the genital tract. It is also very possible to have the presence of cytotoxic antibodies that actually kill the spermatozoa.

Autoimmunity also has an effect on fertility of an individual as the failure of the testis or the ovary can result from autoimmune processes. The effect of autoimmunity on fertility is that it causes failure of the testis or the ovary and this can be detected in the blood sample of affected people. It also causes a case in which the body “sees” its own cell as foreign object and thus causes early pregnancy loss and miscarriage.Autoimmunity can also affect the foetus by passive transfer of an antibody that has pathogen effect which can cause foetal heart block and heart failure thereby causing death

Antiphospholipid Syndrome (APS) occur in women and once its occurs in women with reproductive failure and no other clinical problem , then it can be called primary APS and if there is the presence of other autoimmune disease, then it is called secondary APS . It affects the placenta cells directly and thereby causes loss of pregnancy both at early and late stages.

High level of Natural Killer Cells (NK Cells) is another abnormality in the immune system that causes infertility. NK cells play a very vital role in the success and failure of pregnancy. They are the major immune cell-type found in the uterus. Normally, their number increases through menstrual cycle to the time of implantation of the embryo to the peak, at the time of implantation, the number increases to 70 and then at 20 weeks starts decreasing and absolutely absent at the end of pregnancy but when the increase happens and then no decrease as the pregnancy grows, then it can cause miscarriage. They also have receptors that can bind directly with placental cells and thus produce some potentially dangerous proteins called type 1 cytokines that automatically causes miscarriage.

Treatment of Immunological Infertility

Immunological infertility can be treated and cured, depending on the cause, period, and goal of care, through options like drug prescription, immunosuppression, Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) or Intracytoplasmic insemination (ICSI). Your doctor will discuss the best treatment option for you in the management of infertility caused by immunological factors.