Immune Infertility-What is the immune infertility?
Immune infertility is the cause of infertility due to immunological factors. Immunological infertility accounts for about 10-30% of infertility patients, which includes anti-sperm antibodies, anti-endometrial antibody, anti-egg antibody, and other types of immune infertility. The most common clinically, compared with anti-sperm antibodies to produce immunity infertility caused. Woman's reproductive tract inflammation, the local exudation increase, the immune cells into the reproductive tract, reproductive tract mucosal infiltration want to change, and enhance the absorption of sperm antigens, bacteria and viruses and other infectious agent may be used as natural adjuvants, enhance the body immune response to antigens of the sperm, the reproductive tract in the local and blood anti-sperm antibodies affect sperm motility, interference impede fertilization and lead to infertility
Immune infertility - an overview of the diseaseFemale reproductive structure diagram infertility infertility as a reproductive disease, has now formed an independent subject of an infertility, infertility is not a single disease, but more than 150 kinds of clinical manifestations of the disease. Many factors can cause male and female infertility, infertility, 40% of male problems can cause infertility, 50% of female problems can cause infertility, and another 10% unexplained cause of infertility infertility. Infertility disease threatening the modern statistics show that the WHO / HRD, global infertile couples has reached 6000 - 80 million pairs. China infertility infertility disease are increasingly high incidence of infertile couples have a pair, according to statistics every eight pairs of husband and wife. Infertility disease across medical areas.
Spontaneous immune normal sex life circumstances, the body of any one part of the reproductive process to delay pregnancy for two years or more, known as autoimmune infertility. Immune infertility have a broad and narrow sense. Generalized immune infertility is the body's immune antigens hypothalamus - pituitary - ovarian (testicular) axis of any one organization, women can be expressed as anovulation, amenorrhea, men can be expressed as reduced sperm or reduced sperm motility. Commonly referred to as autoimmune infertility refers to the narrow, infertile couples in addition to the presence of immune anti-sperm immune or anti-zona pellucida, the other aspects.The reproductive system of female genital self-antigen in both sexes can stimulate the immune response, resulting in autoimmune infertility, immune infertility and women such as male anti-sperm anti-zona pellucida of immune infertility. Sperm antigens can also cause women the same kind of anti-sperm immune response, known as the same kind of anti-sperm immune infertility. The complex reasons for infertility cause infertility because there are many, resulting in infertility because the woman's reason, man's reason, both men and women of reason. The key to the treatment of infertility is the cause of infertility clear, only clear of infertility causes, in order to symptomatic treatment.Immune infertility is a relative concept, refers to immunization reduced fertility, and temporarily lead to infertility. Sterile state sustainability depends on the interaction between the immune system and fertility, strong immunity, fertility, infertility occur, if the latter is stronger than the former pregnancy. Infertility often have a variety of factors at the same time, the immune factors can also be used as the sole cause of infertility or coexist with other causes.
Immune infertility - disease mechanismsPregnancy mechanism of the body's immune system to protect the self-antigen, to identify and exclude the role of foreign antigens. Under normal circumstances, due to the balance coordinating role of the immune system, not body antigen immune injury; foreign antigen can stimulate the body to produce an effective immune response, depending on the nature of the invading antigen dose, invasive route of invasion of body the immune status and with or without adjuvant. The same antigen to stimulate different body, even in the same antigen to stimulate the same body at different times, different immune effects.
A. Male anti-sperm antibodies that produce sperm for their own antigen, but it is only in adolescence, by its own immune system recognizes as "others". However, the blood-testis barrier hindered the contact of sperm antigens and the immune system does not produce anti-sperm immune response. If the blood-testis barrier development imperfect or destroyed, such as surgery, trauma, inflammation, leading to sperm spills or macrophages into the reproductive tract ingest sperm cells, sperm antigens activate the immune system to produce anti-sperm antibodies.Another possible reason for the anti-sperm antibodies reduce the number of suppressor T cells or decreased activity. The cells are found in the subcutaneous tissue of the epididymis and vas deferens. Under normal circumstances, by the rete testis and its output pipe leaking a small amount of sperm antigens can activate suppressor T cells, mature B-cell antigen recognition process becomes slow, reduce the body's humoral immune response to sperm antigens to form immune tolerance . When the number of suppressor T cells or decreased activity and semen supplement the lack of suppressor T cell factor, can produce anti-sperm antibodies.Two. Produce normal semen anti-sperm antibodies in women with prostaglandin E, and a glycoprotein with immunosuppressive effects, the semen precipitin have anti-complement activity. These immunosuppressive factors can inhibit a woman's immune competent cells under normal circumstances the immune response against sperm antigens to induce immune tolerance. If the husband semen immunosuppressive factor deficiency can cause the woman to produce anti-sperm antibodies. Couples of reproductive tract infection can cause a woman to produce anti-sperm antibodies, may be caused by the infection of local non-specific immune response to strengthen. Clinical studies have shown that white blood cells in the male semen to increase significantly associated with a woman's reproductive tract of local and serum anti-sperm antibodies, suggesting that the infectious agent as natural adjuvants, immune cells and sperm antigens involved in the female reproductive tract, to produce the same kind of anti-sperm immunization.
Reproductive tract mucosal damage, sexual intercourse, the sperm antigens can damage the mucosal epithelial barrier to enter the subepithelial T lymphocytes, to produce anti-sperm antibodies. Heterosexual anal intercourse or oral sex is one of the reasons that women produce anti-sperm antibodies. In addition, some assisted reproductive techniques such as direct intraperitoneal insemination, can lead to a large number of sperm into the abdominal cavity, after phagocytosis by macrophages in the abdominal cavity, sperm antigen delivery to the pelvic lymph node helper T lymphocytes, and induce anti-sperm the immune response to a temporary anti-sperm antibodies in serum increased.
3. Anti-sperm antibodies interfere with fertility link(1) anti-sperm head antibodies can interfere with sperm capacitation and the first grain reaction.(2) cytotoxic antibodies in the complement participation of the sperm cell membrane damage, sperm death, the end of dry anti-sperm antibodies inhibit sperm motility.(3) the Fc portion of anti-sperm antibodies and cervical mucus glycoproteins interfere with sperm through the cervical mucus of ovulation.(4) anti-sperm antibodies, opsonization enhanced local reproductive tract phagocytes phagocytosis of sperm.(5) anti-sperm head antibodies can prevent the sperm and the zona pellucida and egg membrane, inhibition of fertilization.Immune infertility - the types of diseasesImmune infertility of immune infertility is divided into the alloimmune local immune and autoimmune three categories.1 alloimmune refers to the man's sperm and seminal plasma as antigen to produce antibodies in the woman's body, so that sperm agglutination or sperm lose motility. Under normal circumstances, women do not produce an immune response, only about 15% -18% of infertile women in vivo anti-sperm antibodies. In women, menstrual or endometrial go far disorders, endometrial damage or anal intercourse, the sperm and its antigenic material to easily enter the bloodstream and stimulate the immune response of women.Local immunity refers to the cervical mucosa and endometrium of some infertile women contain lymphoid cells to produce immunoglobulin G and A, containing anti-sperm immunoglobulin G, A and M in the cervical mucus. Therefore, cervical and female genital tract on sperm local immune function.Autoimmunity is the male sperm, seminal plasma or egg of female genital tract secretions, hormones, and overflow the reproductive tract into their surrounding tissue, causing his body's immune response, produce antibodies substance in the body, affect sperm motility or follicular maturation and ovulation. Some studies have confirmed that 5% to 9% of infertile men the body of anti-sperm antibodies are present, the causes may be due to the bilateral vas deferens obstruction or ligation, or suffering from severe reproductive tract infections.Immune infertility - the cause of diseaseEndocrine cause infertility 1. Anti-zona pellucida antibodies cause infertility because:(1) anti-zona pellucida antibodies cover the sperm receptor located in the transparent tape, so that sperm can not identify the receptor, there can be no egg.(2) The antibody can be a stable and transparent with a surface structure, and thus resistant to sperm acrosin on the dissolution of the zona pellucida, the sperm penetration can not zona pellucida.(3) If fertilization, due to transparent with the stability of the structure of the embryo is cementing in the zona pellucida, and can not implantation.
Two cervical immunological causes of infertility: sperm antigen in the vagina and cervix can be macrophages and cells phagocytosed sperm antigen assisted lymphocytes in the immune response induction and activation of immunocompetent cells generation. Which carry blood to the genital tract of anti-sperm and lower sperm survival rate. The other hand, sperm antigens, including the testis-specific lactate dehydrogenase isoenzyme (LDH-C4), the guinea pig sperm plasma membrane-specific protein (PH 20), sperm protein. 10 (spermpro-rein, 10, SP 10), human sperm antigen 63 (Ilumanspermantigen.63 of HSA a 63), rabbit sperm autoantigen (rabbitspermautoantigen, RSA), mannose ligand receptor (1igand the-mannosereceptoi · L, MR), creatine phosphokinase (creatinephosphatekinase CPK). Fertilization antigen (fertilityantigen.1, FA.1) in a human and mouse sperm surface-specific glycoprotein. Cleavage signal antigen (cleavagesignalantigen a 1, CSA-1), and so on, but also via the cervix and vaginal mucosa wound into the body, stimulate the immune system to produce anti-sperm antibodies of IgA, IgM and IgG.It has been reported that anti-sperm antibodies cause infertility mechanism of inhibition of sperm penetration of cervical mucus anti-sperm and lower sperm survival rate, or the inhibition of sperm capacitation, acrosome reaction and fertilization. Therefore believe that one of the important cause of cervical immunological function disorders are also female infertility.
(3) sexual intercourse frequency also induced by the woman's immune infertility, one important reason. Sperm and semen contains a variety of proteins, for some women to produce specific immune response, if frequently repeated contact with the husband's sperm and semen, these heterosexual protein as an antigen substance absorbed by the female reproductive tract, it is easy to stimulate the body to produce anti-sperm antibodies. That this antibody has two: one is called agglutinating antibody, called brake antibodies, and when the sperm move to the cervix, if you encounter the former sperm will adhere piled up each other bound, lost the capability of the female reproductive mucosal absorption, resulting in the formation of the vicious cycle of immune infertility. If the sperm encounter the latter, make the action of the sperm is blocked, so that the sperm and egg can not meet. In addition, the "brake antibody" also allows the contraction of the uterus and fallopian tubes to weaken, affecting the sperm to move to the uterine cavity, so even if we manage to fertilization, implantation, but also tend to make the embryonic developmental disorders and the possibility of early abortion.
Immune infertility - diagnosisDetection method to diagnose a cervical immune infertility include: ① The sperm agglutination test (spermagglutinationtest); the ② the hybrid agglutination test (mixedagglutinationtest); the ③ sperm immobilization test (spermimmobilizationtest :); (4) enzyme-linked immunosorbent assay (ELISA); ⑤ The immunofluorescence test (direct and indirect method); (6) antiglobulin radioimmunoassay; ⑦ immunobead binding test (immune-pearl'bindingtest IBT). Normal fertility couples serum, sperm, semen and cervical mucus anti-sperm antibodies detection rate of <2%, while the detection rate in infertile couples from 5% to 25%. Infertile women and their husbands in serum anti-sperm antibodies IgA, IgG detection rates, the former were 5.42%, 5.79%, which were 18.92%, 12.63%. Infertile women with cervical mucus IgA of IgG were detected in 1.8% and 8.18%. Male infertility sperm surface antibodies IgA, IgG positive rates were 13.42% and 150.3%.Immunological infertility diagnostic criteria: (1) pregnancy more than three years; (2) except for infertility caused by other reasons; (3) reliable detection method to confirm the in vivo anti-fertility antibody; (4) in vitro experiments confirmed the anti-fertility immune interference of sperm-egg binding. Of the four standards to meet the first three clinical diagnosis can be made immune infertility, meet the four criteria is certainly a clinical diagnosis.Immune infertility - treatmentThe existence of high concentrations of sperm antibodies caused the infertility treatment for male autoimmunity caused by the body, to try the treatment of the following methods:(1) immunosuppressive therapy. The use of adrenal corticosteroids, treatment with small doses of a longer period of time depending on the circumstances, or high-dose treatment, decreased sperm antibodies in the body to a certain extent, the same room, in order to increase the chances of conceiving.(2) to collect semen, sperm surface attached to the antibody was washed away and then use the special sperm washing liquid and artificial insemination.
(3) to ketone rebound therapy. Physiological activity characteristic of testosterone, the application of large doses of testosterone, the first of seminiferous epithelium inhibits then disable testosterone, seminiferous epithelium generated by disinhibition sperm, which is testosterone rebound therapy. Reduced sperm count, the antibody titers fall or disappear, select the same room when the antibody has not been significantly increased sperm count rebound, increase the chances of conceiving.
(4) to consider, such as autoimmune orchitis, epididymitis, inflammation, and need aggressive treatment of primary disease.
Antibody-induced autoimmune infertility, the female body to try condoms sex law or at the same time taking corticosteroids, immunosuppressive agents for treatment.(1) to avoid antigen exposure: each sex to use condoms to avoid sperm antigen to further stimulate the woman's. To be the woman sperm antibody levels decline, encourage patients to go to condom sex life in ovulation, or artificial insemination.(2) immune suppression: adrenal corticosteroids have anti-inflammatory, interfere with the cytotoxicity of macrophages. Therefore can be used for the treatment of immune infertility.(3) the artificial insemination of the uterine cavity: when the patients with cervical mucus-sperm antibodies interfere with fertility, may be her husband's semen in vitro treatment, separation of high-quality sperm for artificial insemination. This method avoids the restrictive effect of sperm antibodies on sperm through the cervical mucus.(4) in vitro fertilization: the sperm and egg in vitro fertilization, implanted in the uterine cavity 3-5 days after fertilization, the sperm before fertilization without containing local contact of sperm antibodies in the woman's reproductive tract. After fertilization, the fecundity and transparent with the protective effect, so that sperm antibodies can not attack the fecundity, after embryo implantation.Immune infertility - dietImmune infertility immune infertility symptoms and pathology, the experts asked the following dietary therapy, Yi Xie adjuvant therapy, disease control and treatment faster.Malnutrition will affect the female's ovulation law, can also affect men's sperm quality, long-term balanced diet will couple to conceive is reduced. Too little fat can interfere with women's menstrual regularity. Therefore, if a female beauty excessive weight reduction, which may affect ability to conceive.Experts recommend that women best weight control within the scope of the standard weight plus or minus 10%. The other hand, the high-fat foods, weight gain, will result in the female menstrual disorders, ovulation bad. In addition, caffeine also reduce the chances of conceiving.Excessive carotene may affect ovarian progesterone synthesis and secretion decreased, and some may even be caused by menstruation, ovulation, menstruation turmoil. If a large number of eating carrots, can cause high blood carotene, the emergence of infertility, amenorrhea, ovulation and other anomalies.Through diet, change the pH of the human body, creating a suitable environment in the sperm, eating some acidic foods rich in calcium, magnesium food. For example, the salt content of dairy products, beef, eggs, milk and peanuts, walnuts, almonds, whole grains, aquatic products. Potassium, sodium, alkaline food, including: soda crackers, excluding butter, snacks, fruit juice, starchy vegetables in the food, such as sweet potatoes, potatoes, fruits, chestnuts, and so on.Food additives may also cause infertility. Diet and environmental pollution can not be ignored. Chemicals, food additives such as monosodium glutamate and beauty products "phthalates" may affect the fertility of men and women. Western countries in terms of diet, many studies confirm that food additives such as MSG, it will affect the normal function of male sperm. And monosodium glutamate accumulated in the body trend. "Phthalates" will result in male sperm count decline also make women's ovarian function affected, thus affecting female fertility. It can also be found in nail polish, hair spray, perfume and other beauty products.
Immune infertility - Digital hydrodynamic expansion of the melting treatment of immune infertilityTechnical Overview of Digital hydrodynamic expansion melting technique:[1] Digital hydrodynamic expansion melting technique to use water power automatic control technology, the use of digital hydraulic system, precise automatic calculation of the fallopian tube hydraulic capacity, injected into the special blue liquid, the use of the fallopian tube of blue liquid, hydraulic expansion, and use tiny bubbles on the surface tension test, automatic feedback of pressure and volume of blocked fallopian tubes, timely diagnosis adhesion, illness does not make sense, and intelligence to increase hydraulic injected dissolved fallopian tube obstruction, and increased biological special pairs of oxygen dissolved drug within the first 30 seconds expansion after melting, fallopian tube obstruction hydraulic separation wall free after drugs quickly dissolved, the discharge of the fallopian tube to achieve the purpose of rapidly clear the fallopian tube to avoid the pain of repeated examination of the traditional technology. In order to completely prevent re-blockage of the fallopian tube, treatment after with external hyperthermia treatment, such as CT and light waves, ultra-short wave diathermy, drug iontophoresis method, promote blood microcirculation, will be able to completely clear the interstitial portion of the proximal tubal and other parts to prevent oviduct again adhesions.
Digital hydrodynamic expansion melting technique traditional PK hydrotubation:The lack of traditional liquid flow: First, repeat the conventional liquid flow could damage the tubal peristaltic and ciliary swing capability. The second is to do a traditional liquid flow once the chance of infection, disinfection is not strictly the case of the original tubal is not very serious to do through the liquid may further aggravate. However, due to the traditional liquid flow is a catheter fluid into the uterine cavity, uterine volume and surface area is much larger than the cross sectional area of the catheter and tubal cavity, according to the principle of fluid dynamics, the pressure is equal to the force area per pressure. So the pressure to inject the liquid into the fallopian tube is very limited, very limited therapeutic effect.
Digital hydrodynamic expansion dissolved surgery characteristics and advantages:
Digitized hydraulic system, precise automatic calculation of the fallopian tube hydraulic capacity, timely diagnosis of adhesions, unreasonable disease and injected into the special pairs of oxygen dissolved drug within 30 seconds the first expansion, melting, disposable clear the fallopian tube, to avoid the traditional pass liquid to repeat the disadvantages.
Immune infertility - artificial inseminationAutoimmune infertility, autoimmune infertility in recent years, a common disease.The common types of autoimmune infertility. There are several common types of immune infertility: sperm agglutination, brake, cytotoxic antibody; anti-sperm antibodies LDHX; anti-acrosomal antibody; anti-sperm specific alkaline protein - protamine antibodies; anti-zona pellucida antibody; anti-follicle stimulating hormone antibody; anti-yellow luteinizing hormone / chorionic gonadotropin antibody. Immune infertility, semen. The men take semen masturbation semen shot in a sterile glass container or ceramic container sterile container to maintain the same temperature and body temperature, the temperature should not be too high or too low, the cold weather should be immediately sent to laboratory place the incubator for future reference, to be semen liquefaction after 30 minutes after washing, upstream approach After centrifugation, the upper reaches of suspension spare. Semen processing time, the general should be chosen in the wife's ovulation period.
Immune Infertility insemination. First, determine the ovulation period. Measuring urinary luteinizing hormone peak method, the score of cervical mucus method, basal body temperature measurement or B ultrasound monitoring methods can more accurately determine the specific date of ovulation. Under normal circumstances, you can choose during the follicular diameter greater than 18 mm diameter greater than 18 mm follicles suddenly disappear, urinary luteinizing within 15-24 hours after the hormone peak, fertilization success is most likely. The basic method of insemination. Insemination is a relatively simple matter, accept insemination were not painful, does not appear serious complications. Insemination must be carried out in the hospital, directly to the semen treated with a catheter into the uterine cavity within the sperm density is generally 0.4 per ml-l ten million. Raise the buttocks, sit for about 1 hour after fertilization.In vitro treatment of semen adaptation cases. Women should have the normal ovulatory cycles, normal biphasic basal body temperature, after inspection to determine the fallopian tubes, cervix, uterus and other reproductive organs, other aspects of the marriage living together for more than 1 year, did not take contraceptive measures and pregnancy, semen conventional check the vitality, density, motility, liquefaction and other key indicators is normal, anti-sperm antibodies in female serum positive or weakly positive, the male's own sperm antibody positive or weakly positive results adverse consecutive three cycles of ovulation sex test, in vitro sperm - spouse The cervical mucus contact test bad can deal with the in vitro indication of the semen can be intrauterine insemination. Of course, relatively easy to treat patients, not necessarily first of all take this approach to achieve the purpose of conception, through medication, and treatment should not last long, the way we use in Integrative Medicine, would have good effect.
