Answer from: Wael Saab, MRCOG, Bsc
The combination or the association between autoimmune illnesses and fertility has been an ongoing debate for years. Right now, at the moment, these are not evidence-based associations so whether the Royal College or the American College, they don’t consider autoimmune illnesses to be one of the main causes of infertility. Yet, there’s lots of medical literature about the matter, there’s also some journals discussing that, for example, there’s the American Journal of Reproductive Immunology where this is a growing field of research. Autoimmune illnesses to simplify the matter is when your body starts attacking its own self and why we have this question always asked in the context of infertility because the context is that if I have my immune system is attacking my cartilage or my nerve cells or whatever in multiple sclerosis or rheumatoid arthritis: why I don’t think along the lines that my immune system is attacking my embryos and preventing my embryos from implanting. You will find two extremes in the field. Some people don’t believe in that at all, some people will say that this might be associated to some extent in a specific sub-category of patients. In that scenario, in that case, sometimes, some clinicians give immunotherapy. Again if offered immunotherapy you have to have a detailed discussion with your clinician about that, about what are the drawbacks, what are the evidence available, what are the views of governing bodies like the HFEA for instance regarding that and so on. Other autoimmune issues are like anti-sperm antibodies whether the anti-sperm antibodies is present in the ejaculatory in the blood again lots of debate about it whether it really contributes to not because the concept behind that is, the anti-sperm antibodies is clumping the sperm together, preventing the sperm from reaching the egg so, the sperm is not reaching the egg. So we mentioned that the immune system might prevent embryos from implanting, this is one theory. The other thing is immune things are attacking or are preventing the sperm from fertilizing. Again lots of debate about it, sometimes the embryologist will end up washing the sperm, to get rid of those antibodies. Sometimes they might decrease the concentration quite significantly, again, sometimes this might help, sometimes it might not help. Again, it’s a very sensitive matter, a very sensitive topic when it matters when lots of research is still undergoing, and is being done on the matter at the moment. We cannot rule out that completely as a cause but whenever you want to discuss immune issues whether autoimmune issues or whether antisperm antibodies make sure to discuss it with your doctor to discuss with you the most advanced data about the matter at the moment.
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