AUTOIMMUNE DISORDERS AND INFERTILITY

Infertility is a reproductive problem that can be caused by a number of issues such as:

1. Gynaecological Diseases
2. Endocrine Disorders,
3. Infectious Disease,
4. Circulatory Disease
5. Aging and
6. Cellular Health.
7. Autoimmune Disorders

AUTOIMMUNE DISORDERS AND INFERTILITY

Autoimmune Disorders have been shown to play significant role in many unexplained cases of infertility. This is particularly true for autoimmune diseases such as:

• Endometriosis
• Autoimmune thyroiditis and
• Systemic lupus erythematosis
• Premature Ovarian Insufficiency (POI),
• Polycystic Ovarian Syndrome (PCOS)

Endometriosis

• Endometriosis has many autoimmune components including elevated levels of cytokines, and T- and B-cell abnormalities. Peripheral monocytes are more active, and peritoneal macrophages are present in higher numbers with higher activity levels. This causes increased inflammatory cytokine release.

• There are alterations in B-cell activity and an increased incidence of auto-antibodies in women with endometriosis. Like classical autoimmune diseases, endometriosis has been associated with:
• polyclonal B-cell activation,
• immunological abnormalities in T- and B-cell functions,
• increased apoptosis,
• tissue damage,
• multiorgan involvement,
• familial occurrence/possible genetic basis,
• involvement of environmental co-factors, and
• association with other autoimmune diseases.

• TNF-a, levels are elevated in the peritoneal fluid of patients with endometriosis.

• TH2 mediated immunity humoral responses are commonly elevated.

Autoimmune thyroid disease and infertility.

• Thyroid diseases involving anti-thyroid antibodies have been correlated to infertility and increased pregnancy loss.

• Autoimmune thyroid disease, even in the absence of hypothyroidism has been associated with infertility and reduced response to fertility treatment.

• It has also been associated with gluten-related autoimmunity.

• Autoimmune thyroid disease can lead to hypo or hyperthyroidism which can impact fertility and cause miscarriage.

Other Autoimmune Diseases and Fertility

1) Antinuclear antibodies (ANAs ) which have been associated with infertility can be present in conditions:

• SLE,
• Sjogren’s syndrome,
• Raynaud’s syndrome, and can also be detected in women with a history of exposure to chemicals such as bisphenol-A.

2) Addison’s Disease

• Addison's Disease is associated with anti-ovarian antibodies which can reduce ovulatory function and cause premature ovarian failure in severe cases.

3) Celiac Disease:

• Patients with celiac disease may have multiple nutritional deficiencies that can lead to infertility.

• Celiac disease has been linked to recurrent miscarriage, pregnancy complication and infertility.

• A 2010 study found that between 5-10% of women with a history of stillbirth, recurrent miscarriage, intrauterine growth restriction, and infertility were seropositive for transglutaminase IgA compared to 1% of the control group. Latent celiac disease may be a major cause of unexplained infertility.

4) Premature Ovarian Insufficiency(POI)

• In approximately 20% of women with premature ovarian insufficiency(POI), autoimmune factors can be found.

• POI can be linked to autoimmune thyroid disease, Addison’s disease, or SLE or may have unknown etiology.

• Women may have antibodies against the ovarian tissues, or reproductive hormones such as FSH.

5) Anti-sperm Antibodies

• Anti-sperm Antibodies are another cause of infertility. These can be present in either male or female patients. They are commonly found in males after vasectomy procedures, and their presence can make vasectomy difficult to reverse.

• Anti-sperm antibodies affect the ability of the sperm to penetrate the egg or reduce motility by attaching to the tail of the sperm . They have also been associated with antiphospholipid antibodies.

• Anti-sperm antibodies are generally produced by CD19+/5+ B cells and are associated with elevated natural killer cells and anti-DNA antibodies.

6) Autoimmune blood clotting disorders

• Disorders with increased antiphospholipid antibodies( APAs) including anti-cardiolipin antibodies cause a hyper-coagulation state in the blood and can be associated with reproductive failure and recurrent miscarriage.

• These antibodies can be found in systemic diseases such as SLE, or on their own.