When defence turns into attack or the 7 most common questions about immunity & fertility

Every day, our immune system protects us from viruses, bacteria and other threats. But at times, its defenses can turn against us—even against a deeply desired pregnancy. Immunological causes of infertility are among the most insidious: they are not visible, they cannot be detected without special tests, but their consequences can be dramatic - repeated miscarriages, failed embryo implantation or unsuccessful attempts at artificial insemination. The most common questions about immunological causes of infertility are answered by our doctor Karin Cerna, MD, a leading expert in reproductive immunology who helps women every day to unravel the invisible obstacles on the path to a child.

Can I tell in my body that my difficulty getting pregnant or carrying a child is immunological in origin?

Every day, our immune system protects us from viruses, bacteria and other threats. But at times, its defenses can turn against us—even against a deeply desired pregnancy.

Immunological causes of infertility are among the most insidious: they are not visible, they cannot be detected without special tests, but their consequences can be dramatic – repeated miscarriages, failed embryo implantation or unsuccessful attempts at artificial insemination. The most common questions about immunological causes of infertility are answered by our doctor Karin Cerna, MD, a leading expert in reproductive immunology who helps women every day to unravel the invisible obstacles on the path to a child.

When is it a good idea to think about a possible immunological factor for fertility disorder and refer the patient to a reproductive immunologist?

Immunological tests are particularly useful in the following cases:

• Repeated miscarriages (2 or more consecutive pregnancies).
• Unsuccessful IVF attempts (especially if the embryo repeatedly fails to nest or has an early miscarriage).
• Known diagnosis of autoimmune disease (e.g. Hashimoto’s thyroiditis, lupus erythematosus, Crohn’s disease, antiphospholipid syndrome, multiple sclerosis, etc.).
• Repeated failure of embryo implantation without any other apparent cause.
• Suspected immune-mediated bleeding disorders (e.g. thrombophilic conditions related to antiphospholipid antibodies).

I have an autoimmune disease. Do I automatically run a higher risk of an immune disorder that could jeopardize the success of my pregnancy?

Not necessarily, but the risk is higher than in women without autoimmune diseases. Autoimmune diseases are often related to a disruption in the balance between the body’s defence mechanisms and tolerance to its own tissue – which can also affect pregnancy tolerance. For example, women with antiphospholipid syndrome have a higher risk of miscarriage, and women with untreated celiac disease may have a higher risk of infertility. On the other hand, if your autoimmune disease is well controlled, the chances of a normal pregnancy are high. Therefore, it is important to plan your pregnancy and have the disease under control before it starts.

I had cancer, I am cured and the oncologists have no objection to my pregnancy. Should I be worried that my immunity will function differently after cancer treatment and negatively affect my efforts to have a baby?

This depends on the type of cancer treatment you have had. Chemotherapy and radiotherapy can affect not only the ovaries but also the immune system. Some drugs can change the balance of immune cells in the long term, which could theoretically affect embryo implantation or pregnancy delivery. However, if you have normal immune function and your doctors have approved the pregnancy, the chances of successfully conceiving and carrying a baby are good. In some cases, immunological testing before pregnancy may be appropriate to rule out any risks.

I have been diagnosed with immunological causes of fertility disorders. Does this mean I will never have a child of my own?

No, an immunological disorder does not automatically mean infertility. Often it is an imbalance in immune responses that can be treated or influenced. For example, some women have overactive immune cells (e.g. NK cells) that can interfere with embryo implantation – and this can be corrected with medication. It is important that both your immunologist and gynaecologist help you to tailor the appropriate treatment to your situation.

I was diagnosed with immunological causes of fertility disorders and recommended treatment with drugs affecting immunity. How and for how long will this treatment change my susceptibility to infections?

It depends on the specific treatment. Some medications, such as low-dose corticosteroids, can slightly suppress certain components of the immune system, but usually do not cause a major weakening of the immune system. Other drugs, such as immunoglobulins or intralipids, are more targeted and do not increase the risk of infections. The duration of effect of treatment varies – some drugs work only while they are being taken, others may have a longer impact. Your immunologist should explain exactly how the treatment works and what precautions to take if necessary.

I was referred for an immunological examination, but at the time of my first visit to the immunologist I was less than a week after my first abortion. The immunologist did not invite me for blood draws until a few weeks later. Why?

After a miscarriage, natural changes occur in the body’s immune system and hormonal balance. Some laboratory values could be affected by acute changes related to the abortion itself, and the result of the tests would not be conclusive. Therefore, the immunologist will usually recommend waiting a few weeks to allow the body to return to its “resting” state and for the test results to match your long-term immune settings. This approach helps to get the most accurate picture of your situation and set up the optimal treatment.