Immunological infertility

What is called “immunological infertility” is a condition in which anti-sperm antibodies form in a woman's body, blocking the function of sperm. The antibodies form in relation to a particular man, resulting in the blocking of the functions of his sperm, while sexual intercourse with other men does not cause such problems. This is due to the individual immune response to the sperm of a given partner. The symptoms of the disease disappear as soon as there is a change in sexual partner.

Problems of immunological infertility

According to the World Health Organization (WHO), up to 15% of young couples under the age of 38 suffer from immunological infertility.

The main problem is related to the production of anti-sperm antibodies in the body, which can affect both women and men. Depending on the source of infertility, it can be a man or a woman.

Apart from the differences between the sexes, different degrees of severity of the disease are distinguished based on the following indicators:

• count of anti-sperm antibodies;
• the class of antibodies;
• the degree of influence on the functioning of sperm.

Antibodies can be detected in the blood or ejaculate of the subject, or in their partner in the environment of the cervical canal and uterus. Antibodies lead to impaired fertility, particularly blocking sperm motility and causing damage to the sperm membrane, making fertilization more difficult. The production of antibodies can also lead to a pathology of spermatogenesis with a decrease in the number of spermatozoa that can go as far as their complete disappearance. Another negative consequence is a decrease in sperm motility.

Immunological infertility can be diagnosed by examining both sexual partners. Tests are prescribed in cases where standard tests do not reveal the origin of the conception problem.

Features of the examination

In cases of immunological infertility in both women and men, the following diagnostic procedures are prescribed:

• immunogram;
• compatibility test;
• analysis of the vaginal environment;
• analysis of the quantity of anti-sperm antibodies in the blood of both partners.

During the examination, particular attention is paid to studying the penetration ability, compatibility of partners, and other parameters affecting the reproductive capacity of the couple.

There are several tests to evaluate the different factors characterizing the compatibility between sperm and cervical mucus, including the postcoital test, the MAR test, and the Shuvarsky test. The timing chosen to perform the postcoital test is important: it is necessary to determine the exact ovulation period of the woman and perform the diagnosis during the periovulatory period. The analysis requires material obtained within the first six hours following sexual intercourse.

The MAR test allows determining the number of spermatozoa that have been affected by anti-sperm antibodies. If more than half of the spermatozoa are covered with antibodies, immunological infertility is diagnosed, which requires special treatment procedures.

Methods for treating immunological infertility

The choice of therapeutic scheme is determined by the results of the examination, taking into account the number and class of anti-sperm antibodies, their degree of influence on the functioning of sperm, as well as the general health status of both partners. This allows for selecting the most effective therapeutic option, which may include the following methods:

• Immunosuppressive therapy: administration of medications that suppress the immune response to reduce the production of anti-sperm antibodies.
• Afferent therapy: removal of autoantibodies through plasmapheresis to reduce their negative effects on sperm.

As part of the immunological treatment of infertility, intrauterine insemination is also performed for three or four cycles. It is also possible to resort to sperm donation or in vitro fertilization (IVF) to help the couple achieve a successful conception.

These treatments help overcome the immunological barrier, thereby increasing the chances of successful conception and the birth of a healthy baby.