Аutoimmune factors by infertility
Various autoimmune disorders can cause repeated pregnancy loss or recurrent implantation failure: antiphospholipid, antithyroid, and antinuclear antibodies. Blood tests reveal an autoimmune problem in about 30% of women with the so-called ‘unexplained’ cases of repeated pregnancy loss. A woman can have one or several such disorders.
The management of autoimmune risk factors includes treatment regimens with low dose heparin, corticosteroids and/or aspirin. A different approach, which has proven very successful in recent years, is the intravenous application of high doses of immunoglobulin (IVIg). Adequate therapy can result in successful pregnancy in more than 70% of women with confirmed autoimmune disorders.
In pregnancy, phospholipids act like a glue that binds dividing cells together, and they are also needed for the successful growth of the placenta into the uterine wall. They also serve as a filter for the nutrients in maternal blood flowing to the foetus, as well as for waste chemicals back from the foetus through the placenta. Antiphospholipid antibodies themselves are not the direct cause of spontaneous abortion. Their presence indicates that an abnormal immune process could be responsible for impaired phospholipid function, which elevates the risks of miscarriage, intrauterine growth retardation, and preeclampsia.
A test panel is recommended to detect the presence of antiphospholipid antibodies, including class IgG, IgM and IgA antibodies to seven phospholipids: anticardiolipin, phosphoethanolamine, phosphoinositol, phosphatidic acid, phosphoglycerol, phosphoserine, and phosphocholine. A positive test result on one or more of those antiphospholipid antibody tests indicates that the woman has an immune response that can be the underlying cause of repeated pregnancy loss. For a definitive confirmation of antiphospholipid antibodies, positive levels have to be sustained in a repeat test after 6 to 8 weeks. Since many women become positive only after they get pregnant, repeat testing is recommended in early pregnancy for all women with a history of repeated miscarriage.
An adequate treatment gives women with antiphospholipid antibodies a 70-80% chance of successfully carrying the pregnancy to term.
Antinuclear antibodies (ssDNA, dsDNA, Sm, RNP, SS-A, SS-B, Scl-70, Jo-1, Histone) target the normal proteins within the cell nucleus. Antinuclear antibodies are found in a number of immune diseases, such as systemic lupus erythematosus (SLE), progressive systemic sclerosis, Sjogren’s syndrome, dermatomyositis, rheumatoid arthritis, etc. A positive result from the antinuclear antibodies test indicates that the woman likely has some autoimmune process going on, which could disturb the development of the placenta and ultimately lead to early pregnancy loss.
Women who have antithyroid antibodies (antibodies against thyroglobulin, TAT, and thyroperoxidase, MAT) are at two times higher risk of spontaneous abortion than women who don’t. Screening by high-sensitivity test for these antibodies is mandatory for all women with a history of two or more miscarriages or impaired thyroid function.