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Immunology
An examination of the immune system of both partners is carried out in cases where a possible immunological cause of a fertility disorder is suspected. It is estimated that a maximum of 10% of
of all sterilities have an immunological cause.
Immunology
Disturbances can occur in both humoral (antibody) and cellular immunity. Diseases such as celiac disease, thyroid disorders, phospholipid syndrome, chronic inflammatory diseases, etc. can affect the fertility of a couple. These diseases can occur covertly, without obvious difficulties. However, they trigger an inflammatory reaction in the body, thus upsetting the balance of immune mechanisms. Pregnancy needs to induce the so-called immunological tolerance, inflammation is harmful to it. The consequence is that women fail to conceive and men in turn do not produce sperm in sufficient quantity and quality.
The aim of immunological testing is to diagnose the cause of the imbalance, which is then treated and restored appropriately. Without sufficient and targeted immunological treatment, IVF treatment failures occur repeatedly, partners become stressed and their health continues to deteriorate.
Examination of a woman
Within immunology, we recommend different tests to women according to their specific problem.
What tests are recommended for women with sterility?
Women with sterility fail to conceive spontaneously. Therefore, we look for the cause of the problems right at the beginning of the process, i.e. at the stage of sperm-egg contact, and supplement them with examinations of basic immunological diseases and cellular immunity tests.
We monitor:
Basic parameters - serum immunoglobulin levels, baseline blood cell counts or blood counts, and CRP - tests focused on basic markers of inflammation.
Reproductive antibodies, i.e., antibodies to sperm, ovary and zona pellucida (egg envelope) - testing looks at the reaction against reproductive antigens.
Antiphospholipid markers - a set of tests for antibodies against coagulation factors that may contribute to the formation of micro-clotting, and thus to embryo healing or miscarriage.
Autoantibodies - Antibodies to nuclear antigens (ANA) are a general marker of autoimmune diseases, anti TPO is found in thyroid involvement, anti TG is found in celiac disease.
AMH (anti-müllerian hormone) - the amount of this hormone correlates with individual ovarian reserve of eggs.
NK cell activity - we culture the patient's blood together with stimulating agents-sperm, trophoblast lineage and a non-specific potent activator and monitor the expression of CD69 sign on the surface of NK and NKT cells. High expression of activation markers after sperm or trophoblast stimulation is indicative of increased cytotoxic reactivity directed against partner/fetal antigens and may affect conception success or increase the risk of miscarriage. Also, NK and NKT cell counts in the blood may not be too high.
Cytokine production--culture the patient's blood along with stimulating agents--sperm, trophoblast line and a non-specific potent activator and monitor the amount of cytokines within the cells. The production of embryoprotective IL-4 and IL-10 is desirable; high levels of embryotoxic IFN-gamma and TNF-alpha are a sign of pro-inflammatory tuning of the organism and a risk due to pregnancy.
What examinations are recommended for women with infertility?
Women with infertility become pregnant but are unable to conceive and give birth to a viable fetus. In this group, it is necessary to investigate more thoroughly whether tolerance to the fetus has been induced at all or whether there is a risk of blockage of the vessels by the microthrombi. Similarly, women who have been pregnant but have had pre-eclampsia or HELP syndrome should be investigated.
Baseline parameters, i.e. serum immunoglobulin levels, baseline blood cell counts or blood counts, CRP - testing for baseline markers of inflammation.
T regulatory cell counts - cells that induce tolerance to the fetus.
Antiphospholipid markers - a set of tests for antibodies to coagulation factors that may contribute to microclotting and thus to embryo healing or miscarriage due to inadequate fetal nutrition.
Autoantibodies - antibodies against nuclear antigens (ANA) are a general feature of autoimmune diseases, ENA antibodies are risky in terms of fetal development, anti TPO occurs in thyroid involvement, anti TG occurs in celiac disease.
AMH (anti-müllerian hormone) - the amount of this hormone correlates with individual ovarian reserve of eggs.
NK cell activity - we culture the patient's blood together with stimulating agents-sperm, trophoblast lineage and a non-specific potent activator and monitor the expression of CD69 sign on the surface of NK and NKT cells. High expression of activation markers after sperm or trophoblast stimulation is indicative of increased cytotoxic reactivity directed against partner/fetal antigens and may affect conception success or increase the risk of miscarriage.
Cytokine production - culture the patient's blood along with the stimulating agents-sperm, trophoblast line, and a nonspecific potent activator-and monitor the amount of cytokines within the cells. The production of embryoprotective IL-4 and IL-10 is desirable; high levels of embryotoxic IFN-gamma and TNF-alpha are a sign of pro-inflammatory tuning of the organism.
What tests are recommended for women with repeated unsuccessful IVF cycles?
For these women, as a rule, an infertility panel is offered. It is essential to consider what type of IVF treatment has been used in the past, whether embryos have not developed, or if the problem was only discovered when they implanted in the uterus.)
As part of a comprehensive view of the issue, it is essential that the man also undergoes the examination. For him, we focus on sperm analysis.
Examination of the man
In the immunology laboratory, methods for determining the quality of sperm in the ejaculate by flow cytometry are established. Cytometric examinations of the ejaculate can be performed on the same sample of ejaculate from which the spermiogram was performed. No further collection is necessary.
Sperm apoptosis test
Apoptosis is the controlled death of cells. It is a natural process that involves the gradual death of sperm, DNA fragmentation and changes on the cell surface. Apoptotic sperm are unable to fertilise an oocyte, but in the early stages of apoptosis they are still motile and therefore microscopically difficult to distinguish from truly living sperm.
The ratio of apoptotic to live sperm determines the quality of the ejaculate. A healthy ejaculate should contain more than 50% live sperm and less than 50% apoptotic sperm. The probability of fertilisation of oocytes increases with a higher proportion of live sperm in the ejaculate.
A high proportion of apoptotic sperm is found in patients with infections, autoimmune diseases or pathologies in the urogenital tract. Therefore, in patients with repeatedly high numbers of apoptotic spermatozoa, treatment by an andrologist or immunologist is recommended.
Apoptotic spermatozoa are more likely to have a damaged acrosome, fragmented DNA, are less motile, and are therefore not suitable for IUI and IVF methods in which the sperm must actively penetrate the egg on its own.
DNA fragmentation in sperm
Determination of the number of spermatozoa with fragmented DNA is performed cytometrically using the TUNEL (Terminal deoxynucleotide transferase dUTP Nick End Labelling) method. The enzyme binds a dye to the sperm DNA and labels the damaged DNA. In a good quality ejaculate, less than 20% of sperm have fragmented DNA. A slightly elevated level is 20-30%. A high value is more than 30% of sperm with fragmented DNA.
The more sperm with fragmented DNA in the sample, the lower the probability of successful fertilization of the oocyte. DNA fragmentation testing is recommended for patients with a high number of apoptotic sperm, patients with several failed IVF cycles (especially if the embryos developed poorly), or patients with diseases that may affect sperm quality.
Further examination
We also offer cytometric examination of sperm and leukocyte concentration in ejaculate, determination of the number of sperm with poor quality acrosome or without acrosomal proteins. Acrosome quality is essential for natural fertilization of the oocyte.
Microscopic examination of the presence of antibodies to sperm is performed. Antibodies can significantly inhibit sperm movement. The examination is particularly recommended in patients with reduced sperm motility (asthenozoospermia).
A disorder of the immune system or autoimmunity may also be the cause of male infertility. The laboratory offers a set of blood tests to evaluate the cellular and humoral immunity of patients and includes basic autoimmune markers.
Examination of couples with fertility disorders
Our aim is to "put things together". Couples who have gone through years of martyrdom trying to have their desired offspring have undergone a series of examinations. However, they have often failed to piece the information together (the examinations have been carried out in many departments independently) and find the reason for the failure. Often only the partner was treated, and the man "normospermik", was automatically considered healthy. By having all the examinations done in one laboratory and usually the couple coming together, we have a comprehensive overview and therefore a better chance of discovering a reason. If the couple has already had immunological tests at another clinic (including allergy), it is advisable to bring the reports to the gynaecologist and have them scanned into the information system.
An immunological examination is advisable:
for couples who have failed to achieve pregnancy after a year of regular unprotected intercourse and for whom other possible causes of sterility have been ruled out,
for women after two primary or one secondary abortion,
for couples after two unsuccessful IVF cycles,
for couples who already have a diagnosed immune-related disease (e.g. autoimmune disease, cancer, etc.).
What immunological tests are offered for infertile couples?
The panels are designed to meet the requirements of the Section of Reproductive Immunology of the Czech Society of Clinical Immunology and Allergy.
The test sets are divided into a basic panel, which contains basic screening tests, and a complete panel, which contains a detailed analysis of a number of parameters, including cell function tests. Depending on the type of disease, the physician will recommend an appropriate set of tests. If we find positivity in the basic panel, we recommend adding the appropriate group of tests. In addition to these so-called "reproduction packages", the immunology laboratory offers, for example, a complete allergy test.
Other treatment options
IVF with donated eggs
We have specialized in treatment with donated eggs since the clinic was founded. Thanks to our extensive database of donors, we can choose the most suitable one for you.
IVF with donated embryos
Thanks to our sophisticated egg donation program, we have the unique opportunity to offer infertile couples treatment with donated embryos.
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