Antibodies cause the development of infertility. Immunological infertility, methods of its diagnosis and treatment

Autoimmune infertility- one of the types of childlessness unknown etiology associated with malfunctions of protective mechanisms. The patient's immune system begins to react to sperm as hostile foreign cells, destroying them. The pathology can be treated if you consult a doctor in time. Therapy in women will be reduced to reducing susceptibility to male gametes, in men - to eliminating the root causes of the pathology.

The autoimmune factor affects not only the possibility of fertilization. It is immune infertility that causes many miscarriages. early stages, and the woman may not even realize that there was a conception.

A diagnosis can only be made after a year of unsuccessful attempts to have a child, since women normally have several anovulatory cycles.

Causes

This infertility factor occurs in both sexes. In women, the body begins to produce antibodies to sperm if the ejaculate, especially containing AsAt, comes into contact with blood and physiological environments, which happens in the presence of inflammation of the reproductive system and other disorders.

A man cannot conceive when, due to injuries in the groin area, his immune system begins to perceive his own germ cells as foreign formations.

But these factors cause immune infertility are not exhausted.

Immune infertility in women

AaAt are detected in the blood and/or cervical mucus female patients. In small quantities, they eliminate weak, non-viable sperm. If the number of antibodies increases, the cervical fluid prevents male gametes from reaching the egg, and if conception occurs, miscarriage develops, since the fetus is perceived by the female body as a foreign entity.

Related reasons:

• benign tumors in the ovaries,
• cervical dysplasia,
• chronic inflammation in the pelvis,
• mechanical damage to the genital mucosa,
• sexual infections,
• other autoimmune diseases (toxic goiter, diabetes),
• pathogenic microflora in the uterus, preventing oppression local immunity in the preimplantation phase,
• increased concentration of leukocytes in the ejaculate and other disturbances in the composition of sperm.

Why are antibodies dangerous?

Typically, sperm do not travel beyond the genitals, but if this happens and sperm with antibodies enters the blood, immune processes are “turned on.” IgA class antibodies are especially dangerous in this regard.

If AsAt is detected not only in the cervical mucus, but also in the woman’s blood, the chances of conception drop sharply, since in such cases even IVF will not help - the antibodies will prevent the implantation of the embryo and its further development.

In addition to AST, antiphospholipid antibodies that interfere with pregnancy can prevent pregnancy. placental circulation and increase blood clotting, as well as Rh conflict with the embryo, which carries specific antigens of the father that are absent in the mother.

Causes of immune male infertility

The most common provoking factors:

• injuries to the testicles, penis,
• consequences unsuccessful operations in the groin,
• urogenital infections,
• inflammation of the testicles (orchitis) and seminal ducts, etc.
• varicocele,
• heredity,
• autoimmune diseases.

Any reasons leading to the penetration of gametes into the blood provoke the production of AsAt, which then disrupt spermatogenesis in both the damaged and healthy testicle. Sperm become sluggish, stick together and therefore cannot overcome the barrier of cervical mucus on the way to the uterus and even fertilize an egg in vitro.

Autoimmune progressive male acquired infertility without timely treatment can lead to complete violation fertility married couple.

Diagnostics

The mechanism of immune reactions is complex and still not fully understood. Therefore, doctors do not always determine autoimmune cause childlessness, classifying it as infertility of unknown origin.

In this case, men need to take a spermogram again for comprehensive analysis. If it turns out that 50% or more of the sperm carry AST, then the reason is precisely the autoimmune male factor.

Be sure to be examined for the presence of sexually transmitted infections, which often provoke malfunctions of the immune system.

Both partners must undergo genotyping using HLA antigens.

Diagnosis of patients

For the diagnosis of AST, women are shown a postcoital test, which allows detecting the process of sperm survival in the cervical mucus several hours after intercourse.

In addition, women donate blood and cervical mucus to directly detect antisperm antibodies.

If there is a history of repeated early miscarriages, the doctor will prescribe karyotyping. Perhaps the reason is that the fetus carries genetic soybeans, so the mother’s body gets rid of it.

Like your partner, you need to be tested for sexual and urogenital infections that provoke disruptions in the immune system, and be examined for chronic inflammation.

If you have a miscarriage, get tested for APS and antibodies to thyroid factors. It will not be superfluous to determine the level of hormones, the dynamics of beta-hCG, progesterone.

Treatment in women

Women are advised to abstain from any type of unprotected sex for at least six months to a year, except on ovulation days. This is an indispensable condition for recovery. It is necessary to eliminate contact with sperm until antibodies stop being produced.

In addition, it is necessary to eliminate surgically and by medication inflammatory processes, genital, urogenital infections and tumors.

From aids Correction of immunity and the use of immunomodulators are indicated.

At the same time, the sexual partner should also undergo therapy so as not to provoke a response from the partner. immune reaction for damaged sperm. If methods barrier contraception will not help eliminate the appearance of AST in women, you can try a course of hormone therapy to suppress excessive immune activity.

In the presence of microthrombi or problems with placental blood supply, it is not recommended large doses heparin, aspirin, steroids.

If pregnancy has taken place, do not neglect maintenance therapy.

Before planning a conception, a preparation stage is required, including normalization of AST levels in the body and psychological rehabilitation.

Therapy in men

Treatment of male autoimmune factor is etiological, aimed at eliminating the root cause.

It could be antibacterial treatment inflammation, restoration of the integrity of the seminal ducts and local circulation through surgery, preventing further injury or infection of the appendages.

The use of glucocorticosteroids (for example, Prednisolone) is also effective to reduce the synthesis of AST in the genitals.

Physiotherapy will help eliminate antibodies from the surface of healthy sperm.

Auxiliary general strengthening measures include vitamin therapy and other methods of activating spermatogenesis.

Application of reproductive technologies

Except traditional methods, reproductive specialists recommend using ART: IVF, ICSI, IUI.

So, if a woman has no problems with embryo implantation, but the reason for childlessness is low quality husband's sperm, AsAt in ejaculate, IVF+ICSI gives good result. The sperm is filtered and the best one is selected healthy sperm, which fertilizes an egg in a test tube. The embryo is then implanted directly into the uterus. At the same time, contact of male germ cells with the aggressive environment of the vagina and cervical mucus is excluded.

VMI, intrauterine insemination, unlike in vitro insemination, involves the introduction of ejaculate directly into the uterus, which also makes it possible to preliminarily improve the quality of sperm and avoid its passage through the cervical canal.

ART technologies have one drawback - they are expensive, but do not provide a 100% guarantee.

Folk remedies

Methods traditional medicine can be used in complex therapy infertility to increase fertility, but how independent method they are ineffective in this case.

Drink sage, knotweed, plantain seeds, linden, aloe, adonis, queen bean or red brush, bee products, if available accompanying illnesses from which these herbs are indicated. Consult your doctor first, because not all plants are compatible with medications. You can use herbs, decoctions, tinctures orally or use herbal medicine for local douching, lotions, making vaginal and rectal suppositories.

Men are shown protein and vitamin diet to improve sperm quality.

Prevention

Avoid any factors that provoke contact of sperm with blood, both in the male and female body: hypothermia, leading to inflammation, chronic infections, injuries. Visit a gynecologist or andrologist regularly for early detection possible problems. To avoid relapses, use condoms on days when the possibility of conception is excluded.

Occurs more often than in women. This pathology is a consequence of a violation protective forces body, while athyspermic bodies (ASAT) begin to be synthesized in large quantities in the body. ACAT suppresses the production of sperm, resulting in a decrease in their activity and ability to fertilize an egg. It also interferes with the production of sperm, perceiving them as a foreign organism. ACAT can be found in blood or semen.

Mechanism, causes and symptoms

The male body produces immunoglobulins, which take part in the formation of immunological infertility. They attach to the sperm, reducing their activity: IgA and IgG (attached to the tail and head of the sperm), IgM (attached to the tail). The most negative impact is on immunoglobulins, which are attached to the head of the sperm and can glue sperm together, destroy or reduce their activity.

All immunoglobulins are found in a man’s sperm and, in the absence of disruptions in the immune system, are protected by the mechanism of suppression of the immune response. The operation of this mechanism may be disrupted when exposed to negative factors:

1. Trauma to the testicles, rupture of the seminiferous tubules.
2. Surgical intervention on the pelvic organs and scrotum.
3. Pathologies of the structure of the male genital organs (undescended testicle, dilated veins spermatic cord) and pathological neoplasms ( inguinal hernia and cyst or hydrocele of the spermatic cord).
4. Infections genitourinary system(chlamydia, herpes, papillomas, gonorrhea).
5. Diseases of the genitourinary system (inflammation of the prostate, testicles).
6. Chemical contraceptives.

Due to the influence of these factors, sperm are released into the blood, causing an increase in the synthesis of ASAT. This is due to the fact that sperm are foreign cells for both the male and female body.

Spermogram is a basic study for immunological infertility

1. The postcoital test provides information about the reaction of sperm to the mucous membrane of the cervix. The study is carried out on the first day after unprotected intercourse, before ovulation. This is done in two ways:

• Shuvarsky's test - the woman's cervix and vagina are examined.
• Kurzrock-Miller test - the mucous membranes of the woman’s cervix and the man’s sperm are examined.

1. The Immunobead test is carried out simultaneously with the MAR test and is similar. However, the results may often not coincide, since the analyzes show different spectra.
2. Latex agglutination helps to establish ASAT in ejaculate, blood or mucus. The advantage is high sensitivity.

Treatment

Due to the asymptomatic course of the disease and the complexity of diagnosis, the question arises: is immunological infertility in men treated or not?

Infertility of autoimmune origin can be corrected, however, it is long-term and difficult process. Treatment is prescribed in accordance with the cause that led to malfunctions of the male immune system and became the cause of immunological infertility.

Infertility of autoimmune origin can be corrected, however, it is a long and complex process

First of all, it is necessary to normalize immune status and to support the immune system, for this purpose, medications are prescribed that reduce the body’s response to histamine, help relieve tissue swelling, and reduce vascular permeability. For immune infertility, androgens are prescribed to improve the synthesis of testosterone and.

The second stage of treatment includes taking immunosuppressive drugs that suppress the synthesis. There are two options for taking glucocorticoids: two to three months in small doses or a week in loading doses.

When the cause of the development of pathology is infection of the genitourinary system, it is necessary to undergo a course of antibiotic therapy. The use of antibiotics not only cures the disease, but also helps reduce antisperm bodies in male body.

In case of absence positive results After applying conservative treatment methods, doctors recommend using assisted reproductive technologies:

1. Artificial insemination (ICSI) during which a high-quality sperm is selected from a man and endoscopically injected into a woman's egg.
2. IVF is a technology by which fertilization is carried out outside the female body. This method is used if a man has at least one high-quality sperm that is capable of fertilization, but has lost activity.
3. Pre-implantation genetic diagnostics, with the help of which the embryo is examined, its sex is selected and possible hereditary diseases are determined.
4. Obtaining sperm using a biopsy or donor.

Treatment with folk remedies

Traditional medicine can be used in conjunction with medications only after consulting a doctor. Traditional treatment It is produced with herbs and beekeeping products, on the basis of which infusions, teas, and baths are prepared. They help strengthen the body, increase potency, and improve erection.

Sage is widely used to treat infertility. To prepare the infusion, you need to pour boiling water over the sage seeds and infuse. For improvement taste qualities You can infuse the hay with linden and add honey.

To normalize blood flow to the pelvic organs, it is recommended to consume pollen daily, collected by bees and drenched in honey.

An infusion of plantain seeds will help increase sperm activity

An infusion of plantain seeds will help to increase the level. You can prepare an infusion from 1 tbsp. l. plantain and a glass of boiling water. Take 10 g daily 4 times a day.

A healing bath will help cope with diseases of the genitourinary system, relieve swelling and improve blood circulation. Most often, plantain and sage are used for this purpose, on the basis of which decoctions are prepared and added to the bath. Should be taken only before bedtime, for two weeks.

Add to course traditional therapy You can use goose cinquefoil (2 tablespoons per 400 ml of boiling water) and mumiyo (take less than one gram). These products are used on an empty stomach in the morning and evening.

Immunological infertility in men it is a consequence of impaired immune function or injury to the genital organs. These reasons lead to an increase in antisperm bodies in the blood, which reduce the activity or lead to the death of sperm. The pathology is curable in half of the cases and requires a lot of time and effort.

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Inability to become parents due to dysfunction immune system- a problem affecting both women and men. Immunological infertility (infertility) occurs due to the production by the body of one of the spouses, or both partners, of a specific secretion called antisperm antibodies - ASAT. This is a serious, difficult-to-treat pathology. Methods for eliminating the failure are hormone therapy, IVF, and other reproductive medicine options.

It is possible to detect male or female immune infertility using hardware technologies, bioassays, and ejaculate analysis. Doctors of various specializations treat immunological infertility in women. Women should contact a gynecologist regarding immunological infertility, men should contact a urologist-andrologist. The immunological status in the absence of pregnancy is determined by tests of both partners prescribed by an endocrinologist.

Many men are unaware of their own immune infertility. It does not manifest itself physically in any way. Men remain active sexual partners with a strong sexual constitution, but the wife does not conceive. Immunological failure, as one of the factors causing infertility, does not affect the amount of sperm, erectile function, duration of sexual contact.

Signs male infertility indirect:

• wife has not been pregnant for more than a year;
• gynecological ultrasound did not reveal tubal obstruction or pathology of uterine development in the woman;
• healthy female body.

The woman is the first to be examined when the desired conception is not possible. Therefore, the listed factors are identified in a timely manner. The next step is to examine the partner for immunological infertility.

Signs of injection of antisperm antibodies (ASAT) in women are expressed in a defect in the implantation of the fertilized egg. With ACAT, the embryo develops with disturbances, it dies and is rejected. The woman does not notice this because the pregnancy period is insignificant. Warning is caused by the inability to get pregnant with an active sexual life and a normal menstrual cycle.

Diagnosis of anomaly

How is immune infertility diagnosed? Tests: studies of spermogram, biomaterial, hormonal tests. The doctor recommends that both partners be examined, since the immunological nature of the reproductive anomaly depends on the health of both the male and female body.

The immunological nature of the failure to conceive occurs in 20% of couples from all infertile families.

This anomaly occurs three times more often in women than in men. What is the reason here? Doctors explain this by the close dependence of the immune and reproductive systems in the weaker sex. lead to gynecological diseases, affecting the processes of egg maturation, fertilization, and gestation.

Methods diagnostic definition immunological infertility include:

• Laboratory analytical study sperm showing fertilizing potential;
• Postcoital Shuvarsky test, designed to identify the quality of uterine and vaginal secretions, counting sperm capable of fertilization after contact that have penetrated the cervical canal;
• Kurzrock-Miller testing- a study similar to the Shuvarsky method, carried out to monitor viable sperm in an environment created in a laboratory;
• MAR test on the fertilizing ability of sperm, with an Igg-class antibody level of more than 50%, a diagnosis of male immunological infertility is made;
• 1BT test, showing the number of antibodies attached to the sperm;
• Availability Determination antisperm antibodies in plasma.

Additionally, the spectrum and quantitative characteristics of antibodies on the sperm are detected, PCR analysis for diseases affecting reproductive function.

Important! Detailed diagnosis involves differentiating immunological from other forms of infertility.

ASAT - antisperm antibodies

How does the human body react to the protein found in sperm? Oddly enough, this is a foreign element for him, so the immune system responds by producing specific immunoglobulins- antisperm antibodies. They attach to sperm, are found in the blood and cervical mucus, and in the peritoneum. Normal indicator AST in the blood up to 60 units. If the concentration is higher, then the sperm changes in quality, the fertilizing ability is reduced or becomes zero.

IMPORTANT! An ASAT concentration exceeding 60 units leads to a decrease in fertilizing ability.

Mechanism of sperm damage by antibodies

What is the essence of such an effect on sperm? Their activity decreases, they stick together and dissolve in cervical and vaginal secretions. The possibility of fertilization of the germ cell is reduced, so the factor of the onset and development of pregnancy is doubtful.

Damage to sperm occurs in the following directions:

• loss of mobility;
• disruption of sperm/egg interaction;
• decreased patency of the spermatic and female genital canals;
• deterioration in the ability to penetrate the egg;
• inferiority of the embryo, a decrease in its implantation capacity.

The examination reveals antibodies against spermatozoa, classified into types:

• IgG class;
• IgA class;
• IgM class.

Their presence is detected in the mucus of one or both spouses cervical canal, uterus, fluid peritoneal, follicular media, in the seed. Spermatozoa are damaged under their influence, the spermogram shows low quality of the ejaculate.

Important! The higher the concentration of ASAT, the more tightly they envelop the sperm and prevent them from performing the function of fertilization.

Conclusion - high concentration ACAT causes two or three or more damaging factors. Antibodies overcome protective barriers germ cells of partners, which leads to immunological infertility.

Causes of immunological autoimmune infertility in men

The immune system works to destroy foreign antigens. For the male and female body, this is sperm protein. Antisperm antibodies neutralize it, causing harm to the reproductive system. This is a natural chain of work defense mechanism. But if there are additional pathological abnormalities, then the threat of becoming forever infertile becomes real.

1. Injuries and surgical operations on the genitals.
2. Inflammation of the genitals - scrotum, phallus, urethra, prostate.
3. - chlamydia, herpes virus, gonococci.
4. Physical abnormalities of the genital organs - testicular torsion, varicocele, cryptorchidism.
5. Oncology of the reproductive system.

These are factors of immunological infertility in men, breaking through the protective blood-testis barrier (BTB), ensuring an increase in the production of ACAT.

Causes of immunological autoimmune infertility in women: obstruction and ASAT injection

Immunological infertility in most women occurs against the background of diseases that lead to loss of permeability of the reproductive tract. Infections lead to changes in uterine receptivity to a fertilized egg. A decrease in tolerance causes a sharp increase in the production of ACAT. The result is disruption of implantation and destruction of the embryo in the first weeks of pregnancy.

Second common condition Doctors call immunological infertility contact with sperm carrying antibodies. Such interaction is sufficient to inject the critical mass of the ASAT. In addition to these reasons, threats to reproductive function of an immunological nature are:

• finding sperm in the stomach and intestines during unconventional sex;
• chemical contraceptives;
• gynecological diseases;
• hormonal imbalance during IVF.

Elimination of conditions of excessive secretory activity means reduction higher level ACAT in all environments. Drug correction of antibody concentrations is used, and factors of dysfunction in the development of genital organs and anomalies are simultaneously eliminated hormonal levels, infections that affect the occurrence of immunological infertility are treated.

Treatment

Is treatment possible? Immunological infertility is not a death sentence; it is treatable. For a married couple, doctors select an individual therapy program, or auxiliary techniques fertilization. Examination of each spouse is mandatory.

Treatment in men

Male immune infertility is treated by eliminating the factors that caused the formation of ACAT. Background pathology is eliminated surgical intervention with defects of the genital organs, or therapeutic methods. A man is prescribed drugs that restore sexual health. The task is the correction of reproductive anomalies. Corticosteroids, proteolytic enzymes, and cytostatics are used.

In addition to therapy, herbal treatment with plantain, sage, and cinquefoil is used.

Recipe with plantain to stimulate sperm motility:
The infusion is prepared from the seeds of the plant. Take a full spoon of seeds and leave in boiling water for 2 hours. Dosage regimen: 10 g before meals 25 minutes.

Recipe with sage to increase potency:
An infusion of seeds is made at the rate of 20 g of dry raw materials and 200 ml of boiling water. It is brewed like tea, infused for 2.5 hours, consumed a tablespoon before meals three times a day.

These products are used for baths. Half a glass of seed infusions is poured into the prepared water. Time water procedure- 15-20 minutes. Solutions are used to stimulate blood flow to the PO. Folk remedies are recommended as additional method, enhancing the effect of medications.

Treatment in women

Female immune infertility involves stabilizing the immunological balance with the help of corticosteroids. Long courses of medications or shock therapy complexes are prescribed. Additionally, antibiotics are used antihistamines. For autoimmune abnormalities, Aspirin and Heparin are prescribed.

To eliminate contact with immunogenic sperm, contraception with condoms is recommended. Over six months, the sensitization of a woman’s body decreases. The injection of allogeneic lymphocytes from a donor or husband, the introduction of Y-globulin helps eliminate immunological infertility.

If therapy is unsuccessful, resort to artificial insemination. IVF program - the introduction of sperm into the uterine cavity, when there are some mobile sperm capable of fertilizing the cell. The ICSI method is used when the fertilizing properties of sperm are negligible. Sometimes a change of partner is recommended.

Collapse

Currently, many causes of infertility have been identified, and this allows doctors to help patients with this diagnosis with greater or lesser efficiency. Immunological infertility in women is not a very common condition (it is not the leading cause of inability to conceive), but it is well known to doctors and can be treated relatively successfully, especially if you seek help from a specialist in a timely manner. What kind of disease is this, how to recognize it and why does it occur?

Definition

Immunological infertility is a condition in which the immune system is overactive. So active that it begins to recognize sperm as foreign organisms, and the body produces special anti-sperm antibodies. They affect sperm, reducing their activity and preventing further progress towards the egg and fusion with it. These antibodies are detected in the secretions of the vagina and cervix during a special test performed after sexual intercourse.

IN in good condition Such bodies can be found in secretions, and do not always lead to infertility. But when there are too many of them, they concentrate on the membranes of the sperm, which leads to a decrease in the likelihood of pregnancy. Since these compounds not only reduce sperm motility, but are also capable of blocking the mechanisms of fertilization itself and cellular preparation for it.

Even if high content In ASAT women, conception still occurs, but the quality of the embryo is very low. It cannot attach to the mucosa and is quickly rejected. The quality of the embryo is so low that the formation of the fetal membrane does not occur, etc. As a result, spontaneous abortion in such a pregnancy occurs at very early stages.

Interestingly, this type of infertility occurs not only in women, but also in men. Sometimes these antibodies (ASAT) can form in the male body. At the same time, they are found in the seminal fluid and prevent fertilization.

Occurrence

The prevalence of this cause of infertility is not quite high compared to other causes causing pathology. For this reason, 5-20% of couples cannot have a child, according to the results various studies. At the same time, all cases are indicated in the calculation, regardless of whether the expectant mother, the expectant father, or both partners have such immunity. The statistics only take into account partner couples under 40 years of age.

Why does it happen?

Why does this condition develop in women? It depends on the characteristics of the sperm. Strictly speaking, they are alien to both men and female body. That is why the immune system reacts to them. But normally, this reaction is insignificant and does not interfere with conception, since there are mechanisms for suppressing immunity to these bodies. When these mechanisms malfunction, when the immune system comes into contact with sperm, infertility occurs.

Why might such a failure occur? There are several reasons for this:

1. Diseases reproductive system and genitals of an inflammatory or infectious nature;
2. Availability increased amount in the seminal fluid of leukocytes (for example, with prostatitis) leads to activation of local immunity in a woman;
3. In the presence of partner’s sperm, which are already combined with his antibodies;
4. Usage medications contraception, incorrectly selected and for a long time;
5. Cauterization of cervical erosion in the past;
6. Injuries and hormonal imbalances, resulting from the attempt in vitro fertilization;
7. Injuries during egg retrieval;
8. Any injuries resulting from medical gynecological intervention.

Also, gradually this condition can cause sperm to enter the woman’s gastrointestinal tract (for example, during oral and anal sexual intercourse). Sometimes the reasons are indirect - for example, the production of antibodies of this type is stimulated by isoantigens (enzymes in sperm), as well as other incompatibility of partners at the cellular level that prevents fertilization.

Signs

When can we even talk about infertility? Such a diagnosis can only be made if the patient has constant sexual contact, including during the period of egg maturation, without the use of chemical or barrier contraception, and pregnancy does not occur for more than one and a half to two years. Immunological infertility can be suspected if no other causes of infertility have been found in either the woman or the man. A definitive diagnosis can be made based on the results of a postcoital test.

There are no specific symptoms characteristic of this condition. Although sometimes women may experience regular processes of embryo death and miscarriages in the very first weeks or even days. But they often go unnoticed even by the patient herself.

Establishing diagnosis

Competent and timely treatment immunological infertility is possible only after a thorough diagnosis. At the same time, both partners need to undergo the study, since the problem may be common and lie in their incompatibility. The following diagnostic measures are used (in general):

• Consultation with a gynecologist for women, consultation with an andrologist for men, joint consultation with a reproductive specialist - if desired;
• Laboratory examination of sperm for men and cervical mucus for women, this will help establish the presence of specific antisperm antibodies;
• Postcoital test to determine how sperm act in cervical mucus and vaginal microflora;
• Examination of plasma to determine the presence of ASAT in it.

Sometimes some other studies are also carried out. An important step Before diagnosing this type, it is necessary to confirm the absence of other causes of the condition.

It is done based on the results ultrasound examination, hormone analysis, etc. It is important to remember that both at this stage and at the diagnostic stage itself, you need to stop taking any hormonal drugs, if they are not prescribed for health reasons.

Treatment of such pathology can be difficult. This is largely due to the specific nature of the condition. After all, antibodies are produced only to the sperm of a particular man. That is, it is quite possible to become pregnant from another partner.

To overcome this condition, the patient is prescribed large doses of corticosteroids, as well as antihistamines and antibacterial agents. That is, the therapy is reminiscent of allergy treatment, since it also suppresses the activity of the immune system. For an autoimmune process, aspirin or heparin is also prescribed.

Using condoms for 6-8 months gives a good effect. Avoiding direct contact with sperm leads to the immune system being less active in the absence of a threat. As a result, after discontinuation of this method, pregnancy may occur.

As for the prognosis, it is quite favorable. In mild cases, it can almost always be cured. Overall, suppression of local specific immunity leads to an increase in the likelihood of conception by 50%.

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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 no obvious disturbances in the functioning of the genitourinary system in each of the partners. 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 affecting fertility in women and men, a malfunction of the 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.

ASAT occurs in both men and 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);
• injuries and surgical operations of 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 intercourse, a woman gets into her vagina and uterus. great amount male reproductive cells. The woman's immune system perceives sperm as foreign cells and starts attacking 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 amount of cervical mucus increases, the cervix rises high and opens slightly - shortening the path to the uterus) and the immune suppression system is triggered. In immunological infertility, the immune suppression system does not work, and women 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 in early pregnancy.

Diagnosis of immunological infertility

To diagnose this disease, it is necessary to involve both members of a 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, immunoglobulins IgG, 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. Elevated levels of ASAT 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

A spermogram is used to study the biological material of a man. 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 correct movement"forward".

The presence of ASAT in sperm can be indicated by the absence of living sperm or their low motility

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.

A couple is diagnosed with infertility only after receiving several consecutive incompatible (bad) postcoital test results

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, as 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, married couple it is necessary to protect yourself 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 medications. 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

The immune status is also affected by prolonged use of adrenal hormones or the use of 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 that prevent the entry male fluid into the female genital organs. The use of such protection methods for 7–9 months will weaken immune protection woman's body from 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 effective means To get 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 reproductive specialist, using specific instruments, implants the male sex 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 genetic abnormalities sperm, female cell or failure of the finished embryo to survive in the body of the uterus.
When performing ICSI, unlike IVF, only one healthy sperm and one egg are used