Immunological infertility. Immune infertility: causes, tests, treatment

All human systems and organs participate in the life of the body. The immune system takes responsibility for protecting the body from foreign cells. However, sometimes malfunctions occur in the immune system and it begins to actively protect the body from sperm, perceiving them as foreign cells. This situation happens not only in women, but also in men and can cause infertility. What is immunological infertility and how to deal with it - we will figure it out.

Immunological infertility in men and women

It happens that a young couple, no matter how hard they try, cannot conceive a child. for a long time. At the same time, there are obvious irregularities in work genitourinary system each of the partners does not have. In this case, the cause of non-pregnancy may be immunological infertility.

Immunological infertility is a disorder in the reproductive function of both sexes, associated with the work of antisperm antibodies (ASAT) in the body, damaging male reproductive cells or reducing their ability to actively move. Of all the factors of fertility disorders in women and men - failure to work immune system accounts for 15 to 20%. However, the frequency of ACAT in the blood and sexual fluids of a woman is approximately two times higher than that of a man. Although previously it was generally believed that antibodies unfriendly to sperm could only exist in women.

Antisperm antibodies can be present in the blood, vaginal mucous secretions, in the intra-abdominal fluid of a woman, and in the blood and semen of a man. In the presence of immune infertility, male reproductive cells in the body of one sex or another are regarded as negative formations. The human immune system comes to the defense of the body and ASATs begin to work, which come in three types:

• IgM - attach to the tail of the sperm, slowing down or stopping its movement;
• IgA - changes the morphology of the germ cell;
• IgG - attaches to the head of the sperm, preventing it from entering the egg;

Immunoglobulins IgM, IgA and IgG can be present in small quantities in any person, however, in case of infertility, the number of such cells significantly exceeds the norm.

Causes of immunological infertility

There are many factors influencing immunological infertility. They are divided into male and female.

Causes of immune infertility in men:

• inflammatory diseases male organs(epididymitis, urethritis);
• infections spread through sexual contact (syphilis, trichomoniasis and others);
• changes in the morphology of the male genital organs (phimosis, testicular torsion and others);
• damage and surgical operations male organs.

Causes of immune infertility in women:

• infections spread through sexual contact (trichomoniasis, syphilis, chlamydia and others);
• inflammatory diseases female organs(colpitis, cervicitis);
• chemical means of protection (suppositories, creams, gels);
• endometriosis;
• previously unsuccessful in vitro fertilization;
• allergies.

With every unprotected sexual contact enters the woman’s vagina and uterus great amount male reproductive cells. The woman's immune system perceives sperm as foreign cells and begins to attack them. In most cases, protective cells only affect weak and inactive sperm, while most male cells still remain viable and move towards their goal. In addition, during ovulation, a favorable environment for sperm is created in the woman’s genitals (the number of cervical mucus, the cervix rises high and opens slightly - shortening the path to the uterus) and the immune suppression system is triggered. With immunological infertility, the immune suppression system does not work, and female immune cells actively and successfully fight all sperm.

Signs of immunological childlessness

It is possible to assume the existence of problems with the immune system that prevent you from having a child if you have the risk factors listed above, especially if both partners have risk factors.

However, the only symptom of the presence large quantity ASAT is a long-term inability to conceive a child in couples with a relatively healthy reproductive system of both partners. Lack of pregnancy can be observed for a year or more of sexual activity without the use of any contraception. Sometimes infertility can result in random miscarriages early stages pregnancy.

Diagnosis of immunological infertility

To diagnose this disease, it is necessary to involve both members married couple who dream of conceiving a child. Only a doctor can make a diagnosis of immunological infertility after conducting several types of studies. Men donate blood and semen to be tested for the presence of ACAT. In addition, both members of the couple are tested for sexually transmitted infections. The woman needs to donate blood and cervical smear. The completion of the study should be an analysis of the compatibility of partners. During the event diagnostic studies, taking hormonal or other medicines should be cancelled.
If immunological infertility is suspected, both partners must be tested

Blood tests for inflammation and antibodies

A man and a woman are involved to check the blood for the presence of antisperm antibodies. Blood is usually donated early in the morning on an empty stomach. A small volume of blood taken from the patient is placed in a plate that is coated with proteins susceptible to ACAT. Within a few minutes IgG immunoglobulins, IgA and IgM begin to interact with proteins and attach to them. After this, the amount of antisperm antibodies in the test sample is measured.

A result from 0 to 60 U/ml is considered normal. This means that there are no antisperm antibodies in the test sample or their amount is insignificant and cannot affect the ability to conceive. The average value is a result from 61 to 100 U/ml. Increased performance AST in the blood - more than 101 U/ml.

Average and increased content immunoglobulins in the blood can affect the ability to conceive. The doctor will be able to accurately interpret the research results based on the patient’s well-being, gender, age and medical history.

Analysis of biological material

For studying biological material men use a spermogram. Spermogram is an analysis of sperm fertility based on the number, size, morphology, sperm activity and other characteristics. Sperm examination is carried out to determine a man’s fertility, as well as before IVF and ICSI procedures. The sperm is collected by the man himself into a special laboratory tube. Before donating ejaculate, you must abstain from sex for 2-3 days. Semen examination involves evaluation physical indicators(smell, color, consistency) and the number of sperm in 1 ml of semen and in its total volume. In addition, the activity of male germ cells, their shape, the presence of sperm gluing with each other or other components of sperm, the presence of mucus and white blood cells(leukocytes), acid-base balance.

Indicators of sperm, by which we can talk about its fertility and the presence of immunoglobulins in it:

• low activity or immobility of sperm;
• low sperm count;
• the presence of pathological forms of male germ cells;
• the presence of a large number of dead cells;
• gluing of sperm to each other;
• a large number of leukocytes;
• pendulum-like movement of cells, instead of the correct “forward” movement.

Changes in morphology, that is, the appearance of pathological sperm, are influenced by IgA immunoglobulins, especially in a situation where their number is significantly exceeded. IgG and IgM class ASATs increase the number of white blood cells in sperm, promoting its thickening; in addition, antibodies in a man’s sexual fluid kill sperm even in the epididymis.

Partner compatibility test

To confirm a woman’s “allergic” reaction to her partner’s ejaculate, the following tests are available:

• Shuvarsky's test;
• Kurzrock-Miller test.

To examine a woman’s biological material for the presence of ASAT, a postcoital test or Shuvarsky test is performed. A postcoital test is carried out after examining the man, as well as after excluding other genitourinary diseases of the woman that may interfere with pregnancy. Shuvarsky's test is performed during expected ovulation - on days 12–14 menstrual cycle. 3-4 days before the sample is taken, the couple must stop sexual relations. A woman's cervical mucus is usually collected 3–4 hours (but not more than 24 hours) after sexual intercourse.

A woman's cervical mucus is assessed for the content and activity of sperm in it. The test result is evaluated:

• as positive (that is, the absence of pregnancies is not associated with the presence of ASAT in the cervical mucus) in the presence of at least 15 mobile male cells in the studied material;
• doubtful - if sperm are present in the mucus, but their number is less than 15, the sperm are immobile or their movements are pendulum-like;
• poor test result (incompatibility) - if several immobilized sperm are found in the material being studied;
• negative result - if there are no sperm in the proposed material. This may indicate that the test was not performed correctly.

In case of doubtful, bad or negative result The test will be repeated after 2–3 months. Only after conducting at least three Shuvarsky tests with a poor result can a doctor make a diagnosis of infertility.

The Kurzrock-Miller test is also carried out to study the compatibility of partners. It is very similar to the post-coital test and is also performed after sexual abstinence, during a woman’s ovulation. However, unlike the postcoital test with the Kurzrock-Miller test, in addition to assessing the interaction of the biomaterial of a married couple, the interaction of the biomaterial of each member of the couple with the biomaterial of donors with children is also assessed. Thus, the Kurzrock-Miller test uses two research methods:

• direct - studying the interaction of the biomaterial of spouses;
• cross - interaction of the biomaterial of each member of the couple with the biomaterial of donors.

With the cross-over research method, on the day of analysis, the woman’s cervical mucus is taken for examination and placed between two glasses. Then, the sperm of her partner and the sperm of the donor are added to the woman’s mucus, after which the biomaterials interact for 5–7 hours at a temperature of 37°C. In the same way, the husband’s sperm is checked for interaction with the wife’s mucus and the donor’s mucus.

Results of the Kurzrock-Miller test:

1. Positive (good) result. The test reveals the survival and activity of the husband's sperm in the cervical fluid of his wife. The probability of independent real pregnancy such a couple has one and it is quite large.
2. Weak positive result. As a result of the test, the activity and purposeful movement “forward” of about half of the sperm are revealed. There is a possibility of a natural pregnancy in this family, but conception may require a long period. Sometimes such families may be prescribed medications that stimulate sperm activity.
3. Negative result. Most likely means immunological infertility. The test results reveal that a man's sperm cannot penetrate his partner's cervical fluid. Chances of independent pregnancy with a negative test result are very small.

Treatment methods

Therapy for immune childlessness is a long process, since it is associated with a complex mechanism - the need to reduce the protective function of a person’s own immune system.

Treatment of childlessness in men and women involves the use of antibiotics, anti-allergy drugs and anti-inflammatory medications. Also, in parallel with taking medications, a married couple needs to protect themselves with condoms for 7–9 months. Long-term obstacle to contact of the female reproductive system with sperm allows to reduce protective function the body's immune system.

If there is no effect conservative treatment With the help of medications, a couple who wants to have a child will be able to resort to in vitro fertilization (IVF) or intracellular sperm injection (ICSI).

Features of therapy in men

To resolve the issue of infertility, a man is prescribed a course of hormonal drugs. Reception hormonal drugs associated with the need to increase the level of the hormone testosterone. Testosterone is a male sex hormone that increases sperm activity, and therefore the ability of seminal fluid to fertilize.

Also, treatment of immunological infertility in men may be associated with surgery aimed at eliminating the pathology that led to the formation of antisperm antibodies. It is acceptable to prescribe adrenal hormones or antitumor drugs.

Features of therapy in women

Treatment female infertility associated mainly with suppression of the sensitivity of the immune system. For this purpose, antihistamines are prescribed, such as Tavegil, Loratadine, Zyrtec. Antihistamines used to reduce the sensitivity of the immune system

Also on immune status affected by prolonged use of adrenal hormones or taking antibacterial agents.

In the case of autoimmune processes, treatment can be supplemented with aspirin. To treat immune childlessness, an antibacterial and antiviral drug- gamma globulin. This method is quite expensive, so it is not very popular. The cheapest treatment for immunoglobulins is the introduction of the husband's lymphocytes into the woman's blood for immunization. Such injections are introduced into the woman’s blood for 3 to 6 months. Also, to reduce the resistance of the immune system to sperm, it is excellent to use condoms, which prevent male fluid from entering the female genital organs. The use of such methods of protection for 7–9 months will weaken the woman’s immune defense against sperm. Such treatments can increase the chances of pregnancy by up to 60%, depending on the complexity of the disease for each individual couple. If conservative methods treatment does not lead to the desired pregnancy, the couple is recommended to undergo ICSI or IVF.

IVF and ICSI for a successful pregnancy

The newest and most effective means of getting rid of childlessness is the ICSI method (intracytoplasmic sperm injection). When using the ICSI method, as well as with IVF, fertilization occurs artificially. However, the main difference between intracytoplasmic sperm injection and in vitro fertilization is that for ICSI only one sperm is selected, which is injected into the egg using a microneedle.

The most active, fully mature spermatozoon is selected, having a structure and shape that corresponds to the norm. The egg must also be fully mature and healthy.

Fertilization is carried out on the day of egg retrieval. An experienced reproductologist, using specific instruments, implants a male reproductive cell into the cytoplasm of the egg. After successful fertilization, the embryo is implanted into the uterus. The ICSI procedure is very complex and expensive. To carry it out, you need sophisticated equipment, special sets of reagents, microscopes, as well as experienced fertility doctors - since the process of fertilization is complex, almost filigree. At the same time, the efficiency of this method is very high. Fertilization of the egg occurs in more than 85% of cases, and pregnancy in 45–65% of cases. The effectiveness of the ICSI method has not yet reached 100%, since there are situations with damage to the egg during the procedure, the presence of genetic abnormalities of the sperm, the female cell, or the finished embryo not surviving in the uterine body.
When performing ICSI, unlike IVF, only one healthy sperm and one egg are used

Currently, infertility is becoming the scourge of our time. Unfortunately, there is an increase pathological processes from all organs and systems, both male and female body. Despite massive programs aimed at preventing the occurrence of such pathological conditions, their number is inexorably growing. After all, the reasons for the inability to get pregnant are both genital. So are extragenital ones. That is, problems not related to the sexual sphere. Half of the causes of infertility in married couples are attributed to infertility on the part of men.

This fact is established and does not need proof. Therefore, it is so important, if there is a problem with conceiving a child, to undergo examination not only for the fair sex, but also for the man.

After all, what is the use of examining and treating a woman if the male factor is present?

Among the reasons male infertility this also happens pathological condition, as immunological infertility.

What it is?

This is a condition in which a man’s body begins to produce special substances - antisperm antibodies, which behave aggressively towards male reproductive cells. They can influence the process of their formation, reducing their quantitative composition and morphological structure. And also on the mobility and activity of male gametes.

Accordingly, the process of fertilization does not occur according to physiological norms or pregnancy does not occur at all.

Immunological infertility in men: causes

The main theory behind the development of antibodies to sperm is the interaction of testicular tissue and the male immune system.

Among the reasons causing such pathological changes in the body of men, they secrete:

• Testicular injuries;
• Infections that can be sexually transmitted;
• Surgical interventions performed on the testicles;
• Pathological condition in the form of varicocele - varicose veins venous network of the testicle;
• Inguinal hernia;
• Cryptorchidism – absence of the process of descent of the testicles into the scrotum;
• Torsion of the male testicle, which leads to disruption of the nutrition of its structures and irreversible consequences, depending on the time of assistance.

Symptoms of immunological infertility in men

Symptoms of immunological infertility in men, as such, are not recorded. However, there may be symptoms of the pathological processes that caused it, for example, pain in the testicle with varicocele, or its absence in the scrotum with a diagnosis such as cryptorchidism. There may be symptoms infectious lesion male genitalia, which caused the manifestation of the production of immune complexes against the body’s own sperm.

For the diagnosis of immunological infertility, it is especially important to find out a good history (whether there was traumatic injury male genital organs, or any surgical intervention on the testicles).

The main symptom that is noted with immunological infertility is the absence of pregnancy without the use of any contraception.

Diagnostics

An analysis for the presence of immunological infertility is the mar test. This is not a separate diagnostic spectrum, but only part of a regular spermogram. In addition to all spermogram indicators, antibodies on the surface of sperm are identified. These substances are called antisperm antibodies. To begin with, the identification of class G immunoglobulins is used, and in some cases, class A immunoglobulins are determined.

When analyzing the results of the MAP test, the percentage of sperm on the surface of which antisperm antibodies are detected is determined. Up to 10% of sperm from their total number are considered to have antibodies physiological norm. Obtaining a result in which indicators of 10 to 50% are recorded makes it possible to assume a diagnosis of immunological infertility. Over 50%, the diagnosis is considered established and is an indication for necessary methods therapy for this condition.

Latex agglutination test. This test is highly sensitive and allows you to directly determine the presence of antisperm antibodies in ejaculate, blood plasma or urogenital mucus.

Immunological infertility in men: treatment

The first direction, which is the main one in the treatment of immunological causes of male infertility, is the elimination of the very cause that caused this pathological condition. That is, if there is infectious agents– carrying out their elimination, when diagnosing varicocele – carrying out surgical treatment, as in identification inguinal hernia.

Can be used medicines, which have an immunosuppressive effect, that is, reducing the possibility of producing these antibodies by the immune system itself. Plasmapheresis can also be performed to purify these aggressive substances.

Immunological infertility is a disorder in reproductive systems women or men. The occurrence of this type of infertility is possible when sperm are damaged by antisperm antibodies (ASAT), which negatively affects reproductive function both partners.

Immunological factor of infertility

Immunological infertility is diagnosed in 5-15% of men and women under the age of 38 years. ASAT is detected more often in women - about 32%, less often in representatives of the stronger sex - 15%.

Causes of immunological infertility

Immunological infertility is divided into female and male. There are three types of ASAT: immunoglobulins of the IgG, IgA and IgM classes. They can be with only one partner or both at once.

Immunoglobulins are contained: in blood serum, in mucous membranes, in intrauterine contents, in glands internal secretion etc. The level of sperm damage will depend on a number of factors. Such as the concentration, quantity, class of antibodies and the structures of damaged sperm.

Immunological infertility in women

Women are characterized by all three types of immunoglobulins, men are more characterized by IgG and IgA

The causes of immunological infertility in the female body have been studied much less well than in men. Spermatozoa are foreign bodies that penetrate the female body. Nature provides protection against such penetration - an immunosuppression system. Ideally, a woman’s antibodies should protect other organs from penetration of foreign bodies, but failures occur, the female immune system begins to attack the partner’s sperm, and as a result, pregnancy does not occur.

There are a number of reasons for the violation immune function ASAT:

• Allergy;
• Sexually transmitted infections (eg, herpes, gonorrhea, chlamydia);
• Hormonal and immune disorders (genital endometriosis);
• Chronic diseases of the genital organs.

Immunological infertility in men

The mechanism of development of immunological male infertility is surprising. Male body produces antibodies against its own sperm.

The reasons for such a violation include:

Infections of the reproductive system (for example, chlamydia, papillomavirus viruses);

• Consequences of injury or surgery;
• Chronic diseases (prostatitis);
• Violation of anatomy (inguinal hernia, testicular torsion).

Video: Immunological incompatibility

Diagnostic procedures

Both partners must undergo testing to establish health in terms of egg and sperm production. This rules out other diseases. Afterwards a lot is donated: blood, fluids of the female genital tract, sperm. These tests are necessary to detect antisperm antibodies in the body. There are a huge number of tests, diagnostic standards and interpretation of the results.

The following methods are used:

1. Shuvarsky's test;
2. MAR test;
3. Kurzrock-Miller test;
4. Bouveau-Palmer test.

A unified algorithm for identifying immunological infertility has not been developed to date.

Mechanism of action of ACAT

Taking advantage special methods Immunofluorescence can detect ASAT, as well as determine the sites of their attachment to sperm. IgG antibodies are usually attached to the head and tail of the sperm, IgM is concentrated at the tail, and IgA can attach to the tail, much less often to the head. If ASATs are attached to the tail of the sperm, then they impede movement, but do not particularly interfere with fertilization. Antibodies that bind to the head block the ability to reproduce.

Treatment of immunological infertility

Unfortunately, in most cases, treatment is ineffective. Complete education It is impossible to exclude ASAT, but it is possible to reduce their number.

A number of procedures are used:

1. Immunosuppressive therapy. It reduces the number of antisperm antibodies in the body and increases the metabolism of immunoglobulins.
2. For male infertility, androgen treatment is used. It increases testosterone, which is responsible for sperm activity.
3. .ISM method (). The woman is endoscopically injected with her partner's sperm.
4. Applies. These are special auxiliary reproductive technologies when fertilization occurs outside the mother's body.

Traditional medicine treatment

• An infusion of red tea also helps with infertility. To prepare it, take a pinch of geranium and pour boiling water over it. Leave for 10 minutes. Reception should be carried out throughout the day for both men and women. Please note that the infusion is made only from red geranium; purple has no healing properties.
• If you are infertile, it is recommended not to drink plain water, add to diet egg yolks, yellow peaches, carrots.
• Can be used as an addition to treatment with decoctions and tinctures medicinal baths. One of the most effective baths A bath made from valerian rhizomes is considered. To do this, you need to take 30 grams of chopped grass, pour a liter cool water, leave for an hour. After this, boil for 20 minutes and leave again for 5 minutes. Strain through cheesecloth and add to the bath. The recommended water temperature is 36–36.5. Take baths strictly before bedtime. Full course includes 12–14 baths.
• Chamomile and calendula douching. You need 1 tbsp. chamomile and 2 tbsp. calendula, pour boiling water, leave overnight. After filtering, douche with the resulting infusion.
• Mix 1:1 calendula tincture, as well as 1% propolis alcohol extract (or can be replaced with 20% tincture). Taking 1 tbsp of the resulting mixture, dilute it in boiled warm water. Douche with the resulting solution. The course is daily and lasts 10 days.
• Brew cinquefoil herb 2 tbsp with boiling water in the amount of 2 cups. l. Wait an hour. Take on an empty stomach.

Of all types of infertility, immunological infertility is relatively rare and accounts for about 10% of cases. Its reasons lie in the conflict between the genes of a married couple. Sperm after entering the uterus is perceived as aggressive foreign body. It turns out that the female immune system works abnormally actively and produces anti-sperm antibodies that destroy the male germ cell that gets inside. Accordingly, the sperm simply has no chance of reaching the egg, and pregnancy does not occur.

The question of identifying immunological infertility as a fundamental reason for the inability to get pregnant remains open. The fact is that antisperm antibodies are also found in blood serum, cervical mucus and peritoneal fluid, even in healthy women. Their number can vary between 5-65%. That is, you need to look for another, more specific reason. At the same time, many specialists prescribe a test for the presence of antibodies and try to provide treatment that can correct their number.

Cause of immunological infertility

This deviation occurs in both men and women. As mentioned above, in women they are synthesized as a reaction to sperm. Located in the mucous membrane cervical canal(less often in tubes), they cause complete immobilization of sperm, that is, their agglutination. Antibodies are formed as a result of sperm-specific antigens entering the secretion of the female reproductive tract.

The appearance of AT is often associated with the reaction of the immune system to various infections: genital herpes, trichomoniasis, gonorrhea, chlamydia, urea and mycoplasmosis. Their appearance is also influenced by chronic inflammatory diseases genital organs (cervicitis, endometritis, salpingoophoritis), genital endometriosis. As a result of too high activity of the immune system, spermatozoa also come under attack, and whether they belong to a regular partner or a casual one makes no difference.

There are cases of autoimmune or allergic reaction to the antigens of the corresponding follicular fluid and the zona pellucida of the follicle. In the body of a healthy man, sperm do not enter the blood, but are isolated. That's why defensive reaction the body to antigen can begin only in the presence of anatomical disorders in the form of an inguinal hernia, varicocele, obstruction of the vas deferens, cryptorchidism, testicular torsion, agenesis of the vas deferens. Sexually transmitted infections, injuries and various operations on the pelvic organs or scrotum are also dangerous. Chronic inflammatory diseases (prostatitis, epididymitis, orchitis) also do not go away without leaving a trace. All this leads to the destruction of the natural barrier between blood vessels and seminiferous tubules, the body perceives unfamiliar cells as hostile and defends itself.

ASAT (antisperm antibodies) are:

• sperm-immobilizing, leading to partial or complete sperm stupor;
• sperm agglutinating, due to which sperm stick together with each other, their speed of movement decreases (sometimes they simply sway from side to side in one place). Of course, the process of fertilization becomes impossible.

Diagnosis of immunological infertility

In order to confidently make a diagnosis of “immunological infertility”, specific laboratory tests are required depending on the gender of the patient. Men must donate blood and semen to be tested for the presence of ASAT and tested for STIs (sexually transmitted infections). If ACAT is detected by any of laboratory methods(MAR test, 1BT test, ELISA/ELISA, etc.) you can see the presence of autoimmune reactions against sperm. If ACAT covers more than 50% of motile sperm, then a diagnosis of “male immune infertility” is made. Women's blood and cervical fluid are taken for analysis, and a series of tests are carried out to determine the compatibility of both partners. These include:

• postcoital test (PCT) - preferably performed after monthly use condom, 6 hours after intercourse;
• Kurzrock-Muller test (the test allows you to evaluate the penetrating ability of sperm in the cervical canal during the period of ovulation in a woman);
• determination of antibodies to phospholipids, to DNA and to factors thyroid gland;
• determination of the genotype of spouses using class II HLA antigens;
• Izojima test (detects the degree of sperm immobility);
• Shuvarsky's test;
• Bouveau-Palmer test.

Treatment of immunological infertility

Various types of corticosteroids, immunomodulators, etc. are used to treat women. The whole process is aimed at suppressing antisperm antibodies. In case of low effectiveness of treatment, there is an alternative in the form of assisted reproductive technologies: intrauterine insemination, in vitro fertilization. With men everything is much more complicated, since in this moment not found yet effective method ridding sperm of ASAT. The only thing left to do is to use artificial insemination methods, the most effective of which is considered to be ICSI - intracytoplasmic injection of sperm into the egg.

Traditional medicine in the fight against immunological infertility

There are also traditional methods treatment of immunological infertility. We bring to your attention several healthy recipes.

1. Infusion of red geranium. Pour boiling water over a pinch of geranium and leave for 10 minutes. Both partners can drink a tablespoon half an hour after eating.
2. Pour 2 cups of boiling water over the cinquefoil herb, 2 tbsp. l. Let it sit for 1 hour. Take on an empty stomach.
3. Valerian root bath. Pour 30 grams of chopped herbs into 1 liter of cool water and leave for an hour. Boil the infusion for 20 minutes and leave to “rest” under the lid for 5 minutes. Then filter through cheesecloth and add to the bath. We take a bath before bed, the water should not be higher than body temperature. The course of treatment is 12-14 baths.
4. Chamomile and calendula douching. 1 tbsp. chamomile and 2 tbsp. Pour boiling water over the calendula and leave for 12 hours. Strain and syringe with the resulting infusion.
5. Mix 1:1 calendula tincture and 1% propolis alcohol extract or 20% tincture. 1 tbsp. l. dilute the resulting mixture in boiled warm water and douche for 10 days.

Especially for- Anya Logue

Content

Immunological infertility causes reproductive dysfunction in 20% of cases. Immunological or autoimmune infertility is a disorder of reproductive function in men and women due to damage to sperm by ASA (antisperm antibodies). Detection of ACAT is considered one of the main causes of infertility. The incidence of pathology is 32% and 15% in women and men, respectively.

What is immune infertility

Processes occurring in the body occur with the direct and indirect participation of the immune system. Impaired functioning of the immune system provokes:

• chronic inflammation;
• disorders of the maturation of male and female reproductive cells, which leads to infertility;
• miscarriage and pregnancy complications.

If we specify what immunological infertility is, it is a condition of the body of a man and a woman of a hyperimmune nature, in which the secretion of antisperm antibodies is noted. Experts conventionally divide immunological infertility into female and male. Immune infertility in women is approximately 2 times more common. Treatment is provided by gynecologists, andrologists and reproductive specialists.

It is noteworthy that ACAT is sometimes present in fertile women and men in small numbers. However, when ACAT is fixed to male germ cells, it reduces the likelihood of pregnancy.

Causes of immunological infertility

Autoimmune factor infertility occurs in both women and men. Immunological infertility often involves damage to germ cells by so-called antisperm antibodies. Sometimes immunological infertility is caused by the whole system genes (HLA) responsible for tissue compatibility. The genes, represented by a group of immune-related antigens, are located on the sixth human chromosome.

Attention! If a couple experiences antigen incompatibility, stimulation of reactions on the part of immunocompetent cells occurs.

Sperm contain a protein that is foreign to the immune system. Thus, the protein structures of male germ cells are considered autoantigens.

Normally, sperm are protected by specific mechanisms that involve suppression of the immune response:

• GTB or blood-testicular barrier of the testicle and epididymis, the ability to mimicry, implying sorption and desorption surface antigens, immunopressive factor of spermoplasm – in men;
• A decrease in the level of T-helpers, C3 and Ig components, an increase in the number of T-suppressors during ovulation - in women.

Antisperm antibodies are produced in women and men. These are immune complexes of the following classes:

• IgA - attached to the tail or head of the sperm;
• IgG – localized in the tail and head;
• IgM - fixed in the tail area.

Important! A fluorescent diagnostic method allows identifying an area characterized by the presence of antisperm antibodies.

ACAT is found in blood, intra-abdominal fluid, cervical secretions and seminal fluid. The normal level of ASAT in the blood is 0-60 U/ml.

Sperm damage may occur varying degrees, which depends on the following factors:

• antibody class;
• number and concentration of ASAT;
• density of sperm coverage with antibodies;
• influence on specific structures of male germ cells.

ASAT has the following varieties:

• sperm-immobilizing;
• spermagglutinating;
• spermolytic.

Attention! It is possible to identify ASATs and determine the localization of their attachment using the immunofluorescence method.

Attached to the tail, ASAT negatively affects only the migration of sperm through the secretion of the cervical canal. There is no significant effect on fertilization. If antibodies are fixed to the head, the ability to migrate is not impaired. Negative Impact due to suppression of the ability to dissolve the capsule of an egg ready for fertilization. Thus, fertilization by sperm becomes impossible.

In women, all classes of immunoglobulins are detected with equal frequency. It is common for men to find IgG antibodies, IgA.

Experts name several reasons leading to immunological infertility due to the destruction of barrier factors:

• genital infections and skin tuberculosis in the genital area;
• inflammatory diseases in men occurring in chronic form– prostatitis, orchiepididymitis;
• increased number of lymphocytes in seminal fluid;
• salpingitis, oophoritis, adnexitis and other inflammatory chronic pathologies among women;
• endocrine dysfunction, accompanied by impaired hormone production;
• allergy to sperm, which is a consequence of immunological incompatibility;
• injuries to genital tissues resulting from various manipulations;
• erosion on the cervix and its subsequent treatment;
• obstruction of the vas deferens, testicular hydrocele, varicocele, cryptorchidism, inguinoscrotal hernia and other anatomical disorders;
• rare intimate life, which contributes to the development of sperm abnormalities;
• use of chemical contraception;
• sexual intercourse with several partners, which provokes exposure of the body to different protein antigens;
• penetration into the stomach and intestines of a significant amount of sperm during oral and anal sex, V abdominal cavity in case of violation of intrauterine insemination technique;
• failed IVF protocol.

Autoimmune infertility can occur due to a complex of unfavorable factors.

Immunological infertility in women

Experts emphasize that autoimmune infertility in women has not been studied enough. As a result of sexual intercourse, a significant number of foreign sperm enter the female body. Male germ cells are distinguished by different antigens. The liquid component of sperm also has a certain effect.

Nature provides a special system of immunosuppression to prevent a reaction to sperm, which is a foreign object. However, under the influence of certain factors and causes, the immunosuppressive system turns out to be untenable. In such cases, the woman’s immune system fights against sperm.

Antibodies are found in women in the secretion of the cervical canal. Their production helps reduce the patency of the genital tract. Excessive production of antisperm antibodies leads to disruption of the implantation mechanism. It is noteworthy that when some antigens are removed from the surface of the genital tract, others accumulate.

Under the influence of antibodies, pathological changes are observed in the balance of T-lymphocytes. Dead sperm differ from those selected by the body genetically for the purpose of penetrating the tube and subsequent fertilization of the egg. They create a blockade of local immunity.

Often, the formed ACATs contribute to the emergence of a local immune response. The immune response is often observed from the cervix. This area contains plasma cells that synthesize IgA and IgG components. Involvement of the inner layer of the uterus, tubes and vagina is sometimes observed.

Warning! Female immunological infertility can be provoked by incompatibility of partners in the Rh-Hr, ABO, and MNSs systems.

Immunological infertility in men

Antibodies are detected in 22% of men with a history of infertility. In 10% of cases, antisperm antibodies are detected in healthy men. A high concentration of antibodies is observed in 7% of men.

During the maturation of spermatozoa, which are first-order spermocytes, the production of antisperm antibodies, which have the form of immunoglobulins, is noted. The effect of antisperm antibodies is manifested in a decrease in motility, immobilization, gluing or agglutination of sperm. Damaging effects include:

• impaired motility of germ cells in men;
• inhibition of interaction between eggs and sperm;
• decreased patency of the vas deferens;
• deterioration of capacitation, which involves preparing the sperm for subsequent penetration into the egg.

The damaging effect depends on the type of antibody. Their concentration is also essential. The following barrier factors are identified that prevent damage to sperm by antisperm antibodies:

• the blood-testis barrier is formed by Sertoli cells located between the blood vessels and seminiferous tubules;
• seminal fluid contains local factors that provide regulation.

Clinical picture

The only sign of autoimmune infertility is impaired reproductive function, which is manifested by infertility for a year or more, spontaneous termination of pregnancy, mainly in the early stages. There are no other signs of immunological infertility.

Men with immunological infertility are characterized by active spermatogenesis, preservation erectile function. Against the background of autoimmune infertility in women, pathologies of the uterus, tubes, endocrine system, which indicates the presence of ASAT.

Important! With immunological infertility in a couple, sexual intercourse is characterized by completeness.

Autoimmune infertility can be assumed in the absence of pregnancy with existing risk factors. Immunological infertility is indicated by endocrine disorders and a tendency to allergies in partners.

Immunological factor of infertility: diagnosis

The absence of pregnancy within a year may indicate the presence of infertility, for example, of an immunological nature. Diagnosis involves conducting an examination to exclude various factors of infertility:

• tubo-peritoneal;
• cervical;
• uterine;
• genetic;
• endocrine.

To diagnose immunological infertility, tests are used: tests of blood, semen, and secretions from the genital tract to detect ASAT. In more than 40% of cases, infertility is associated with the presence of pathology in a man. That is why both women and men are examined.

Diagnosis of autoimmune infertility involves performing a postcoital test after ruling out other possible factors. Postcoital testing involves examining the mucus of the cervical canal and is usually recommended on days 12-14 of the cycle. Sexual rest is required 3 days before the test. The study is also performed 9-24 hours after sexual intercourse. During the diagnostic process, sperm motility is determined using a microscope.

The result of post-coital testing may be:

• positive in the presence of 5-10 motile and active sperm and the absence of leukocytes in the mucus;
• negative in the absence of male germ cells;
• doubtful if the movements of the sperm are pendulum-like.

If a questionable result is obtained, a repeat examination is necessary. The postcoital test also evaluates the number of sperm and the characteristics of the movements they make:

• immobility;
• rocking phenomenon;
• active progressive.

The test result provides one of five assessments:

• excellent or normal;
• satisfactory;
• bad;
• doubtful;
• negative in the absence of sperm.

Additional diagnostics of immunological infertility include:

• MAR test. This is a mixed antiglobulin test that allows you to determine the number of male germ cells that are coated with antibodies. The test was recommended by WHO for the purpose of routine semen screening. You can talk about autoimmune infertility when you receive a test if its indicator is 51%.
• Latex agglutination method. This technique is an alternative to the MAR test and is considered highly sensitive in reducing the motility of male germ cells. Diagnostics can be used to detect antibodies in the secretion of the cervical canal, seminal fluid, and blood plasma. Using the latex agglutination method, it is not possible to determine the number of cells coated with antisperm antibodies.
• Enzyme immunoassay (indirect). Through diagnostics, the amount of antisperm antibodies can be determined. Normal indicator is up to 60 U/ml. Increased concentration noted at 100 U/ml, and an intermediate value from 61 to 99 U/ml.
• Penetration test. It is advisable to use diagnostics if the postcoital test result is negative.

Gynecologists may prescribe the following tests to confirm or rule out autoimmune infertility:

• smear for flora, oncocytology, bacterial culture;
• PCR diagnostics of sexually transmitted infections;
• hormonal status;
• Ultrasound of the internal genital organs;
• colposcopy;
• scraping;
• hysteroscopy;
• laparoscopy.

Men in mandatory They take a spermogram, which allows you to determine the type of movement, structure, number and concentration of sperm, and signs of inflammation. In some cases, consultation with specialized specialists, for example, genetics, may be required.

Important! In some cases, the cause of infertility cannot be determined. In this case they talk about psychosomatic factor or infertility of unknown origin.

Immunological infertility: treatment in men and women

Gynecologists answer yes to the question of whether immunological infertility can be treated. Therapeutic measures for immunological infertility in men includes elimination of risk factors, surgery for hydrocele, varicocele, inguinoscrotal hernia. If necessary, immunostimulants and androgenic drugs are prescribed.

Treatment of autoimmune infertility in women involves taking the following medications:

• antibacterial and anti-inflammatory;
• immunoglobulins;
• immunomodulators;
• antihistamines.

An important component of treatment is the use of a condom for 6-8 months. In the absence of contact between the female body and sperm, the sensitization of the immune system can be weakened.

A few days before ovulation, it is recommended to take medications containing estrogen. Sometimes hormone therapy, including small doses of corticosteroids, is prescribed. Hormonal treatment held in within three months. When an autoimmune process, such as antiphospholipid syndrome, is detected, therapy is supplemented with heparin or aspirin in minimal doses.

Correction of the immunological status in both women and men is considered advisable. This allows you to reduce the amount of ASAT. Subcutaneous administration of allogeneic lymphocytes before conception is possible. Sometimes it is also recommended intravenous administration mixtures of plasma proteins (from different donors).

Androgens are prescribed to treat autoimmune infertility in men. In the presence of background pathology It is advisable to carry out surgical and drug treatment (cytostatics, proteolytic enzymes). If ACAT is present, the area of ​​the testicles responsible for testosterone production may be affected. The hormone determines the activity of the formation of male germ cells.

Important! Before treating immunological infertility in men, you should undergo an examination.

Adequate drug treatment immunological infertility allows for reproductive function. If there is no effect of the treatment aimed at correcting autoimmune infertility, the woman is offered intrauterine insemination.

The effectiveness of intrauterine insemination performed for immunological reasons is up to 20%. Before performing the procedure, preliminary preparation of the partner’s sperm is carried out, which includes the selection of motile sperm. The material is introduced into the area of ​​the uterine fundus in close proximity to the mouth of the tubes.

Intrauterine insemination reduces the distance traveled sedentary sperm for subsequent fusion with the egg. In order to achieve an effect in case of immunological infertility, 2-3 intrauterine inseminations are performed. It is advisable to use the technique before and after ovulation.

If the partner's sperm is inferior due to an immunological factor of infertility, IVF is also recommended. The effectiveness of the method is up to 50%. Eggs and selected sperm are placed in a test tube. The resulting embryos are grown and then implanted into the uterine cavity.

The presence of antibodies in the blood and secretions of the cervical canal significantly reduces the effectiveness of artificial insemination. Antibodies have adverse influence on the processes of fertilization, implantation and subsequent development, the course of pregnancy. A high titer of ASAT is a contraindication to IVF. Necessary long-term treatment until the indicators normalize.

For autoimmune infertility, it is recommended to use ICSI. This is an IVF technique in which a pre-selected sperm is artificially introduced into the cytoplasm of the egg. The method allows you to get pregnant in 60% of cases.

Auxiliary techniques are effective only in reducing the mobility and immobility of male germ cells. Fertilization and the development of pregnancy are possible if sperm have the ability to fertilize.

Attention! The use of auxiliary techniques implies the possibility of using donor material. The donor can become physically and mentally healthy man up to 36 years of age with a clear family history.

Prevention

Experts emphasize that immunological infertility is a consequence various pathologies congenital, inflammatory nature. Sexual infections, disordered intimate life, trauma, and genital abnormalities can lead to the development of autoimmune infertility.

Prevention of immunological infertility includes:

• monogamous intimate relationships;
• timely detection and adequate treatment defects, infections and inflammatory processes of the internal genital organs;
• correction of hormonal imbalances;
• refusal of unreasonable surgical interventions in the pelvic area.

Compliance is essential healthy image life.

Conclusion

Immunological infertility is one of the factors affecting reproductive function in both men and women. Autoimmune infertility does not have clinical picture and has a specific character. ASATs are produced exclusively by the germ cells of a particular man. Changing a sexual partner can ensure pregnancy. Modern assisted reproductive technologies make it possible to overcome severe cases of immunological infertility.