It happens that a couple comes to the doctor with complaints about the inability to conceive a child. After a detailed history taking, long-term laboratory and instrumental examinations of both partners, no visible pathology is detected. And the patency of the fallopian tubes is not broken, and the hormonal background of the woman is in perfect order, and the diagnosis of male infertility has no grounds. In this case, the doctor should think about a third, much more rare, and therefore less studied and understood cause of female infertility - immunopathology.
Anti-sperm antibodies provoke immunological infertility
Immunological infertility is caused by the production of antibodies in the body of a woman to the spermatozoa of a man. Antisperm antibodies can be found in the vagina, endometrium, fallopian tubes, ovaries, but most often antibodies can be found in the mucus of the cervical canal. This mucus is a biological barrier that protects the uterine cavity from infectious agents. Nature is programmed so that on the most favorable days of the cycle for conception, the properties of cervical mucus change: its density decreases, pH and the level of immunoglobulins that protect the uterus from infection decrease. In immunological infertility, immunoglobulins A and G are significantly elevated throughout the entire menstrual cycle, namely, antisperm antibodies belong to them.
Why does immunological infertility occur: the main causes
To date, about 40 ejaculate antigens are known that can provoke the synthesis of antibodies. There are several alleged reasons that provoke the production of antibodies to spermatozoa in a woman's body. First of all, this is an infectious process of the genital organs, in which the infectious agent itself is an antigen to which antibodies are produced, and a cross-reaction can occur. Any surgical interventions on the internal genital organs of a woman, especially abortions, curettage and the installation of an intrauterine device, are very strong immune attacks on the woman's body, which also provoke the production of antibodies. In addition, genetic predisposition may also play a role in immunological infertility.
Tests used to diagnose immunological infertility
Diagnosis of immunological infertility is a rather complicated process. It is this pathology that begins to be suspected only when all other possible causes of infertility are excluded. In addition to determining elevated immunoglobulins A and G in a woman's blood, there are several specific methods for diagnosing immunological infertility. Spontaneous sperm agglutination tests in gelatin allow the detection of antisperm antibodies in seminal plasma. A screening test for detecting antibodies in a woman's blood is the Izojima reaction, in which spermatozoa are immobilized. Immunofluorescent analysis allows you to determine sperm antibodies in the blood, both men and women. The postcoital Shuvarsky-Huner test and the Kurzrock-Miller test, which is a test for the contact of sperm with cervical mucus,
What methods will help cure immunological infertilityTreatment of immunological infertility is a rather complicated and lengthy process. First of all, the couple is recommended to use condoms for at least six months. Thus, in the body of a woman, the production of antibodies to the spermatozoa of a man is suspended. Immunosuppressants are used to suppress the immune response. Glucocorticosteroids are prescribed in small doses for 2-3 months, or as a shock course for 7 days immediately before ovulation and an attempt to conceive. Fertilization with “washed” spermatozoa involves treating them with a physiological buffer with the addition of albumin or human blood serum, as a result of which antibodies are removed from their surface, and fertilization is attempted with such spermatozoa. The method of fertilization through the use of donor sperm is quite widespread. In the absence of the effect of all the above methods of treatment of immunological infertility, the couple is recommended to use in vitro fertilization.
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