Pregnancy is a blessing. Especially if you conceive naturally without going to a fertility specialist, it is also a privilege if you can conceive naturally after undergoing fertility treatments. Yet so, even if the fertility treatments don't help you conceive naturally within a year, you may have to opt for artificial insemination methods like IVF. Your gynecologist and IVF specialist will be your best friend for quite some time or, let us say, a lifetime because if you can carry your baby to term, you will forever keep the doctor in your thoughts. Yet so, this task is not easy if it comes up with a challenging condition called immunological infertility.

What is Immunological infertility?

It would be extremely difficult to explain to a layperson what immunological infertility is in simple terms. Still, Dr. Himali Maniar, a co-founder of the Nisha IVF center in Ahmedabad, has tried to simplify it.

She explains that we should understand the fundamental autoimmune disorder to know about immunological infertility.

Autoimmune disorder:

When a person is affected by an autoimmune disorder, their immune system treats the body's healthy cells as external antibodies and starts attacking them, thereby killing the healthy cells.

So, when a woman is trying to get pregnant naturally, the seminal fluid that enters the woman’s genital tract could sensitize it. The immune system present in the woman’s body produces anti-seminal and anti-sperm bodies and rejects the seminal fluid and sperms by immobilizing them. The sperms fail to make it to the ovaries to meet the egg.

When the sperm is treated as an antibody, the cervical mucous that ideally helps the sperm swim through turns hostile and becomes more acidic than usual, making the sperm weak.

Not only this, there are times when you have been able to carry the first pregnancy to labor successfully. Then every attempt you have made for a second child has failed or resulted in a miscarriage, including repeated IVF failures. These can be attributed to the immunological infertility factor.

Every time an embryo is planted into the uterus, your body’s immune system attacks it; by the time it latches onto the uterus wall, the placental formation begins, the immunological disorder destroys the embryo leading to miscarriage. Or sometimes there will be delayed miscarriages also.

Are you most likely to have immunological infertility?

You may be indicating immunological infertility if:

· Multiple IVF cycles have resulted in miscarriages

· Difficulty getting pregnant the second time

· Your age and preconception genetic screening are deemed fit, yet there are repeated miscarriages even after      multiple IVF attempts.

· You are in your 30’s and seldom fall ill.

How does immunity work against your pregnancy?

Your immune system is your body's armor. It either uses the innate immune system(b-cells) or the latent immune system(t-cells) depending upon the threat it recognizes. From cold to cancer, your body can categorize the threat and accordingly launches an attack on the invading bodies(the sperm or the fertilized egg in this case.).

The Innate immune system is at work if you have not been able to conceive at all since the sperm is being treated as an invader.

The latent immune system is at work if you have been able to give birth to one child, and the subsequent attempts have resulted in miscarriages. Here what happens is that through your first pregnancy, your body has recognized your pregnancy as an invasion, but the specific cells required to fight the attack were unavailable at the time. So, during the course of your first pregnancy, your body has actually generated the cells it will need to fight off the subsequent invasion, i.e.your next pregnancy.

Who is at risk of immunological infertility?

If you are suffering from any of the following autoimmune diseases like type I diabetes, thyroid, rheumatoid arthritis, PCOD, you are at risk of immunological infertility.

Diagnosis of immunological infertility.

Dr. Himali Maniar explains that if you struggle with infertility and recurrent miscarriages, you may need to be tested for autoimmune disorders.

Decrease in Ovarian Reserve: Every woman with infertility should get tested for ovarian reserve. You will be tested for AMH( antimullerian hormone) and FSH(follicle stimulating hormone). As per your age, if these hormones are abnormal, it indicates that your ovarian reserve is decreased, which could probably be due to an autoimmune disorder. The criticality of your decreased ovarian reserve will determine the necessity for other autoimmune tests.

Thyroid: Thyroid is common among women. Even a mild form of thyroid disorder can lead to infertility and miscarriage. So, it would help if you got tested for thyroid disorder.

Antiphospholipid Antibody Syndrome: Antiphospholipid antibody syndrome could be a leading cause for repeated miscarriages or placental abruption in women. You can confirm by getting tested for it. In this autoimmune disease, antibodies produced against one or more of the tissue component of the placenta increases the risk of blood clotting in the placenta and other complications in pregnancy.

Can immunological infertility be treated?

The plan to combat immunological infertility involves treating the specific autoimmune disorder you have and supporting it with fertility treatments. Bringing the autoimmune disease under control can increase your chances of pregnancy. Supported fertility treatments enhance the chance of pregnancy and reduce miscarriage.

Immunosuppressants:

IVIG-intravenous treatments for immunoglobulin G: Your body has 2 types of immunoglobulins: Immunoglobulin M(memory) is a part of the innate immune response system. Immunoglobulin G is an antibody specifically created by the body to fight a specific invader. IVIG infusion suppresses the killer cells in women who have immunological infertility.

Another option is Intralipid Infusion. Parenteral nutrition is given through IV to people who cannot digest food on their own. Intralipids, a mix of nutritional fats, is a part of this PN treatment plan. It has been observed that patients with intralipid infusions had a better immune system and could suppress the natural killer cells.

What is the duration of Immune treatments?

The IVF specialist treats the patient in the conception cycle between day 6 and day 10.

The second round is a day before the embryo transfer.

The third round is after she has tested positive for pregnancy.

After that, her blood works are continuously monitored for cytokines, b-cells, and t-cells. If the count is high, another round of infusion is considered.

This precautionary measure has to be taken up to week 32 of the pregnancy, after which the baby is developed enough to make it on its own in case the mother goes into pre-term labor.

Will a suppressed immune system make me more susceptible to illness?

No, immunosuppressants work only on targeted locations of a high population of immune cells present in the uterus.

Conclusion:

Couples who have undergone a mentally traumatizing time trying to achieve and carry a healthy pregnancy to term heave a sigh of relief when they can come across a doctor who has accurately pointed out the problems and come up with an individualized treatment plan for carrying the pregnancy to term from the team of IVF specialist at NISHA IVF center located at Ahmedabad.

Please book an appointment with us if you are one of those couples hopeful of successful childbirth. Our compassionate team of doctors promises you to hold your hand to the very end.

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