Immune system failure and infertility

DR MAXWELL ADEYEMI

Infertility is the inability of a couple to achieve pregnancy after having constant, timely unprotected sex for at least one year.

If a couple has never been pregnant any time before, it is called “primary infertility", and when the couple has conceived before but is no longer able to do so, it is described as “secondary infertility."

Infertility affects both males and females, one partner may be affected at a time, or both male and female can be affected at the same time.

There are many causes and contributing factors to infertility, among them age, lifestyle, environmental factor, occupational factor, excessive exercise, eating disorder, obesity, poor diet, genetic factors, medications, infections (such as pelvic inflammatory disease), endometriosis, polycystic ovarian disease, ovulation disease, sexually transmitted diseases, hormonal imbalance and abnormalities of the immune system.

While so many factors contribute to infertility, many people remaing in denial, males especially. The reality is there are myriad of factors that may cause or contribute to infertility in both men and women.

One of the causes of infertility is the “abnormalities in the immune system” otherwise referred to as immunological infertility.

Female fertility is regulated by a series of highly co-ordinated and synchronised interactions in the hypothalamic-pituitary-ovarian axis. Therefore, female fertility can be affected by dysfunctions of reproductive tract, neuroendocrine system and the immune system.

Autoimmune mechanism, as well as an increased production of multiple antibodies, are involved in some infertility disorders, unexplained infertility and may be responsible for the occurrence of some pre-eclampsia and spontaneous abortions.

Men can develop antibodies to their own sperms, which may reduce the sperm motility and ability to fertilise an egg.

The immune system is responsible for fighting foreign bodies in the body through the production of antibodies, however, when the immune system can no longer differentiate between a "good" foreign body and a "bad" foreign body, then there is a problem.

Immune infertility is a reproductive disorder that affects men and women and causes their immune system to “wage war on the sperm.”

Women diagnosed with immune infertility usually produce antisperm antibodies (ASA) in their reproductive system. These antibodies act by neutralising sperm, by clumping them together, creating holes in their membranes and physically altering their structure or morphology.

They can also coat over receptors that are involved in the sperm-egg binding and fertilisation process.

Sperm antibodies may occur in either the male or female partner and can be detected in the blood and sexual secretions through some specialised testing.

Some tests can also be done on the sperm after sex to get some clues on the interactions that exist between sperm and the female genital secretions.

Sperm antibodies can also cause infertility by disrupting sperm motility or the binding of the egg.

Sperm antibodies can also be present in the female sexual secretions, which may trap sperm and stop them from moving through the genital tract in order to fertilise the egg. Occasionally, there can also be cytotoxic antibodies that actually kill the sperm.

Autoimmune process in the body can result in infertility as there can be failure of the testis or the ovary. This can cause the body to “see” its own cell as foreign object and attack it causing early pregnancy loss and miscarriage. Autoimmunity can also affect the fetus by passive transfer of an antibody that has pathogen effect, which can cause fetal heart block and heart failure resulting in fetal death, miscarriage or still birth.

Antiphospholipid syndrome in a women affects the placenta cell directly and causes loss of pregnancy both at early and late stages.

Another abnormality of the immune system that can lead to infertility is high levels of the immune component known as natural killer cells (NK-cells).

Natural killer cells play a very vital role in the success and failure of pregnancy. They are the major immune cell types found in the uterus. Normally their numbers increase 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 at week 20 of the pregnancy, it starts decreasing and absolutely absent at the end of pregnancy.

But when the increase happens and there is no decrease as the pregnancy grows, then it can cause miscarriage.

These natural killer cells also have receptors that can bind directly with placental cells and produce potentially dangerous protein known as type-1 cytokines that automatically causes miscarriages.

Infertility caused by immunological problems can be treated depending on the cause.

Treatment option such as immunosuppression, intra-uterine insemination, invitro-fertilization, intra cytoplasmic insemination can be considered in the course of treatment once a cause has been established.

If you are experiencing infertility issues, it is wise to speak with your private doctor or gynecologists who will advise on investigations aimed at identifying the possible cause[s] and then determine the best course of treatment.

Contact Dr Maxwell on 3631807 or 7575411.