Reproductive Immunology

Host Dawn Davenport, Executive Director of Creating a Family, the national infertility & adoption education and support nonprofit, interviews Robert Kiltz, Founder and Director of Central New York Fertility. He is a Diplomate of the American Board of Obstetrics and Gynecology and Board Certified in Reproductive Endocrinology and Infertility.

Hit the Highlights
  • Reproductive immunology is the field of medicine that studies interactions (or the absence of them) between the immune system and parts of the body related to the reproductive system.
  • In a normal healthy body with no immune issues how is the immune system involved in conception and pregnancy? The embryo and then later fetus is half “other” or foreign which would normally activate a woman’s immune system. Why doesn’t it? What is the immune system doing that prevents it from attacking this “other”?
  • The immune system must balance the needs of activation of the immune system in response to challenges with the ever-present danger of attacking oneself.
  • When the immune system is not functioning as it should, what problems do you see with the pregnancy? Recurrent miscarriages, late pregnancy losses and repeated IVF failures.
  • Does the placenta offer protection for the fetus from the mother’s immune system?
  • If so, once the embryo implants and the placenta develops, do immune system problems decrease? Is the woman “over the hump” so to speak after she gets to the ____ week of pregnancy (for example: 6 weeks)?
  • The placenta does allow some parts of the mother’s immune system in, because the fetus is protected by the mother’s antibodies, but does it usually not let in the parts of the mother’s immune system that might attack the fetus as foreign?
  • What is reproductive autoimmune failure syndrome? Wjat are the symptoms?
  • Is reproductive autoimmune failure syndrome generally accepted by the reproductive endocrinologist community?
  • An immune response often causes inflammation, but there is growing evidence that uterine scratching, which presumably causes some inflammation and irritation to the endometrium, is actually beneficial to implantation.
  • If a woman’s immune system is causing her to miscarry or have preterm births or failed IVF procedures, wouldn’t it also be causing other problems in her body? Or is it common to have a normally functioning immune system that goes wonky only in pregnancy?
  • There is some discussion that endometriosis has at least partly an immunological cause. Does the presence of endometriosis indicate that a woman is at higher risk for immune problems in a pregnancy?
  • And if so, what are some of these problems that a patient could be aware of?
  • Is there evidence to support that preeclampsia is caused by an immune system malfunction?
  • Relationship to stress?
  • Various studies have shown that women who frequently had exposure to partners’ semen before conception had a reduced risk of pre-eclampsia. Also, subsequent pregnancies by the same paternal donor had a reduced risk of pre-eclampsia while subsequent pregnancies by a different paternal donor had a higher risk of developing pre-eclampsia.
  • If this is the case, then are women who conceive using donor sperm at greater risk for immune system issues with the pregnancy?
  • Testing: What testing has been supported by published research to determine if a faulty immune response is causing the miscarriages or IVF failure?
  • Is it possible for a blood test to pick up maternal antibodies that might indicate an immune system problem (examples: anti-phospholipid antibodies, antinuclear antibodies, anti-thyroid antibodies).
  • How to test for presence of T or Th cells and NK cells? Are blood tests effective because the NK cells resident in the uterine lining act in very different ways than those that circulate in the peripheral blood?
  • Are antibiotics effective to correct immune system malfunctions that cause infertility?
  • Two therapies used by physicians practicing reproductive immunology are intravenously administered immunoglobulin, commonly known as IVIG, and Humira.
  • In addition to the immunotherapies sub-anti-coagulant doses of heparin are also commonly used to prevent spontaneous abortion. It is believed that heparin acts as an anti-inflammatory agent in a manner analogous to Humira.
  • What are the risks to the fetus of these medicines? What are the risks to the mother?
  • Cost of immunotherapy treatment for infertility?
  • Why is reproductive immunology controversial within the reproductive endocrinology field?
  • Can the immune system malfunctions or disorders also cause male infertiity?

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Image Credit: Sanofi Pasteur