Female Infertility and Serum Auto-antibodies - A Systematic Review

April 22,2022
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SUBURBAN JOURNAL CLUB

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Journal Article: Female Infertility & Serum Auto-antibodies: A Systematic Review

Journal: Clinical Reviews In Allergy & Immunology, Volume 53; Pg. No.: 78-86

DOI: 10.1007/s12016-016-8586-z

The fertility of a couple is defined as their ability to obtain a pregnancy. In humans, fertilizability (monthly probability of initiating a pregnancy) is difficult to estimate but is thought to be about 20% to 30%.

The 12-month rate of infertility (absence of pregnancy despite regular unprotected sexual intercourse) is estimated as 9% worldwide.

The causes of infertility can be divided into three main categories for which the prevalence is variable:

Female causes (33% to 41%)
Male causes (25% to 39%)
Mixed causes (9% to 39%)

The contribution of serum auto-antibodies to infertility remains debated, but some data tend to show its role in infertilities classified as idiopathic.

The authors of this journal article have performed a comprehensive literature review to assess the association of auto-antibodies in female infertility and assisted reproduction.

Table 1: Summary of data available for serum auto-antibodies, in case of infertility, IVF or ICSI-IVF.

	Anti-Phospholipid Antibodies (APL)	Anti-Nuclear Antibodies (ANA)	Anti-tissue antibodies	Thyroid auto-antibodies	Anti-ovarian antibodies	Others
Female infertility	Higher prevalence in infertile females (12% vs. 2% in normal). Weak influence of APL in fertility.	Increased prevalence seen in female infertility (20% vs. 3% in normal fertile women).	Higher prevalence of anti-smooth muscle antibodies (35% vs. 3% infertile women).	Higher prevalence of anti-TPO and anti-TG (16% in infertile population).	Higher prevalence, especially in women with early ovarian insufficiency.	Higher prevalence of ASCA and of CD associated auto-antibodies.
IVF	Higher prevalence of anti-beta-2-GP1 level (20%). But, no association between APL and the results of IVF.	Lower rate of implantation and pregnancy (14% vs. 32.4% in normal fertile women). Positive correlation between ANA level and fertility rate.	NA	Lower rate of fertilization implantation and pregnancy.	Higher prevalence.	NA
ICSI-IVF	No association between APL and ICSI-IVF.	NA	NA	No difference in the prognosis of ICSI-IVF.	NA	NA

APL: anti-phospholipid; TPO: thyroperoxydase; TG: thyroglobulin; ANA: anti-nuclear antibodies; B2-GP1: beta-2-glycoprotein-1; ASCA: anti-Saccharomyces cerevisiae antibodies; CD: celiac disease; IVF: in vitro fertilization; ICSI-IVF: intracytoplasmic sperm injection-IVF; NA: not available

Table 2: Simplified auto-immune tests proposed for infertile women at admission to an ART program.

Auto-immune pathology	Assays
Auto-immune endocrinopathy	TSH, T3, T4, anti-TPO antibodies, anti-TG antibodies, plasma cortisol
Aspecific auto-immunity	ANA, anti-tissue antibodies, complements (CH50, C3, C4), serum protein electrophoresis
Anti-phospholipid antibodies	Lupus anticoagulant, anti-cardiolipin antibody, anti-B2-GP1 antibody, blood platelet count, TPHA-VDRL, anti-prothrombin, anti-phosphatidylserine antibody
Celiac disease-associated antibodies	IgA and IgG anti-transglutaminase antibodies, IgA and IgG anti-endomysial antibodies
Other	ASCA, ANCA

TSH: thyroid stimulating hormone; TPO: thyroperoxidase; TG: thyroglobulin; ANA: anti-nuclear antibodies, B2-GP1: beta-2-glycoprotein-1; ASCA: anti-Saccharomyces cerevisiae antibodies; ANCA: anti-neutrophil cytoplasmic antibodies. The recommendations in italics have not been proven and have been proposed by the authors of the review article.

The full article can be accessed at: https://link.springer.com/article/10.1007/s12016-016-8586-z

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