Reproductive Immunology ...when the immune defence becomes the adversary
Conception sometimes fails to occur even when all other investigation findings are within normal limits. The underlying cause may be an immunological imbalance interfering with fertilisation, embryo implantation or the maintenance of an established pregnancy. Reproductive immunology facilitates the identification of these occult associations and enables targeted therapeutic intervention.
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We take a holistic approach to treatment. Because every detail shapes the future. Only when we engage with your complete history can we help guide it towards a successful conclusion.
Why Reproductive Immunology Plays a Pivotal Role in the Management of Infertility
The immune system is designed to protect the organism. In the context of reproduction, however, it may on occasion mount a response that impedes conception or compromises healthy gestational development. It may, for example, generate an aberrant immune reaction against spermatozoa, the embryo or, at a later stage, the placenta. The consequences may include recurrent miscarriage, recurrent implantation failure, failed IVF cycles or obstetric complications.
Reproductive immunology specifically addresses the relationship between immune function, fertility, embryo implantation and pregnancy. It helps identify situations that standard investigations frequently fail to detect, and seeks to correct the disrupted immunological balance in a targeted manner.
Immunological causative factors are often occult. They are frequently not associated with overt clinical symptoms and cannot be reliably identified without specialised diagnostic testing.
When We Recommend Immunological Investigation
We consider reproductive immunology particularly in situations where conception repeatedly fails despite other apparent causative factors having been excluded or adequately treated. We are guided especially by the following clinical scenarios:
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Failure to conceive following a prolonged period of regular unprotected intercourse
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A history of recurrent pregnancy loss
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Recurrent implantation failure or early pregnancy loss following IVF
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A history of failed IVF cycles or multiple failed embryo transfers
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A previous pregnancy complicated by pre-eclampsia, HELLP syndrome or fetal growth restriction
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A diagnosis of an autoimmune disorder
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Chronic or recurrent gynaecological infections
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A history of oncological disease or treatment
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A desire to exclude a possible immunological contribution to infertility prior to commencing treatment
Sometimes this provides the first definitive answer after a prolonged period of uncertainty. At other times, immunological assessment confirms that the causative factor lies elsewhere. In either case, it enables you to take the next step with greater precision.
Contextualising Your Journey
At Europe IVF, we do not regard immunological investigation as an isolated diagnostic test, but as an integral component of comprehensive care for the couple presenting with infertility. We interpret results within the full context of the medical history, prior treatment, IVF outcomes, pregnancy losses and any additional diagnoses. Your history for us does not begin with a laboratory result, nor does it conclude with a single recommendation.
We therefore integrate reproductive medicine, genetics, laboratory diagnostics and reproductive immunology so that the treatment strategy is coherent as a whole. Only when we understand the complete picture can we seek a pathway to its successful continuation.
Three Pillars of Our Reproductive Immunological Care
Identifying the underlying cause
The immunological factor may involve the female or male partner; bilateral assessment is therefore important in a significant proportion of cases.
MUDr. Karin Černá
MUDr. Karin Černá is an experienced physician with specialist certification in clinical immunology and allergology. She has extensive experience in the diagnosis and treatment of immunological disorders, and at Europe IVF she specialises in reproductive immunology. She helps patients identify occult immunological factors that may underlie infertility, recurrent pregnancy loss or failed IVF cycles. MUDr. Karin Černá has over 24 years of clinical experience in immunology.
Her approach combines specialist expertise, meticulous interpretation of results and individualisation of treatment — qualities of particular importance in reproductive immunology, given that an identical laboratory finding may carry different clinical significance across individual patients.
How Reproductive Immunological Assessment is Conducted
Assessment always commences with a consultation and comprehensive evaluation of your medical history, prior treatment and current clinical situation. Only on this basis does the physician propose a scope of investigations that is specifically meaningful for your case.
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Consultation and medical history reviewWe review your reproductive history, pregnancy losses, prior IVF cycles, other medical conditions and the results of all previous investigations.
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Proposal of targeted laboratory investigationsThe scope of testing varies according to whether the clinical question concerns failure to achieve conception, recurrent pregnancy loss, implantation failure or a suspected specific immunological aetiology.
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Specialist interpretation of resultsThe laboratory finding alone is insufficient. Of critical importance is its true clinical significance within your specific context.
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Individualised treatment planIf an immunological factor is confirmed, treatment is tailored accordingly and its efficacy is monitored prospectively.
Investigations Relevant to the Female Partner
The scope of investigation in the female partner is determined by the specific clinical scenario — whether conception has not been achieved at all, whether recurrent pregnancy losses are occurring, or whether we are addressing implantation failure following IVF. Investigations may include the following:
Assessment of fundamental immune and inflammatory markers, including serum immunoglobulins, full blood count with differential, and CRP.
Including ANA, anti-TPO, anti-tTG and antiphospholipid antibodies. These tests may help identify autoimmune associations that could increase the risk of infertility, miscarriage or obstetric complications.
Assessment may include antibodies against spermatozoa, ovarian tissue or zona pellucida. These reactions may play a role at an early stage of the conception process.
In selected cases, the activity of peripheral NK and NKT cells is assessed, as elevated cytotoxic reactivity may impair embryo implantation or increase the risk of pregnancy loss.
The balance between pro-inflammatory and embryoprotective cytokines may be of clinical significance. In simplified terms, a successful pregnancy requires a degree of immune tolerance rather than an exaggerated inflammatory response.
Assessment of selected complement components, in particular MBL, whose deficiency may be associated with early or late pregnancy losses or complications such as pre-eclampsia.
Where peripheral blood investigations are within normal limits but clinical suspicion of an immunological aetiology persists, assessment of uterine natural killer cell populations directly within the endometrium can be performed.
Male investigations
Reproductive immunology is not exclusively a concern for the female partner. A comprehensive approach to the couple presenting with reproductive dysfunction requires systematic investigation of the male partner, with a specific focus on semen analysis. In untreated or overlooked immune disorders, a reduction in the number of fertilisation-competent spermatozoa or deterioration in sperm motility parameters may occur.
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Semen analysis (spermiogram)
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Ejaculate volume and pH
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Sperm concentration, progressive motility, morphology and vitality
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Leucocyte count
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Detection of antisperm antibodies as indicated
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Acrosomal integrity and intra-acrosomal protein assessment as indicated
KIR Genes and HLA-C: When Implantation Fails Despite Good-Quality Embryos
A specific area within reproductive immunology is the analysis of KIR genes and HLA-C antigens. KIR genes encode the receptor molecules of the female innate immune system, whilst HLA-C antigens are expressed on every embryo — including those derived from donated oocytes. Where there is no appropriate immunological compatibility between the two, the maternal immune system may mount an exaggerated response and reject the embryo even in the absence of other identifiable pathology.
This test helps determine whether the embryo is able to correctly engage the implantation process via its surface antigen expression. The result may also inform the selection of an appropriate treatment protocol or assist in optimising donor-recipient matching. Results are typically available within a few days from a routine venepuncture.
Find out more about KIR genes and HLA-C
Frequently Asked Questions
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Can I identify an immunological problem myself?
In most cases, no. Immunological causative factors tend to be occult and can generally only be identified through laboratory investigation. However, a history of recurrent pregnancy loss, unexplained failed IVF cycles or a known autoimmune disorder may serve as clinical indicators.
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Does a confirmed immunological cause mean I will never conceive my own child?
No. An immunological disorder does not automatically equate to absolute infertility. It is frequently a modifiable imbalance amenable to treatment or pharmacological intervention.
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I have an autoimmune condition. Does this automatically mean there is a problem?
Not automatically, although the risk may be elevated. The critical factor is optimal disease control and treatment planning in collaboration with a specialist.
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Do you also investigate male partners?
Yes, assessment of both partners is essential for accurate treatment planning.
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Vyšetřujete i muže?
Ano, pro správné nastavení léčby je důležité vyšetřit oba partnery.
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