Can the success rates of egg donation treatment be affected by an immune disorder?
The relationship between fertility and immunology is closer than many realise. In fact, immunological issues are one of the main causes of miscarriage and implantation failure. Many patients affected by immune system disorders may not even be aware of their condition. We asked three experts to explain the precise connection between immunology and reproduction.
Our experts are:
- Dr. Luboš Vlček, GYNEM Fertility Clinic, the Czech Republic
- Dr. Jennifer Rayward, ProcreaTec, Spain
- Dr. Laura de la Fuente Bitaine, Clinica Tambre, Spain
Answer from Dr. Luboš Vlček
Immune disease is a very common complication in the treatment of infertility by donor egg acceptance. Immune disease could affect the treatment and the success rate of a patient who has an autoimmune disease in her medical history. There are many autoimmune diseases which the patient can be affected by—some of them even could be hidden and not explored yet. For example, we have patients with Type 1 diabetes or thyroid disfunction which are caused by autoimmune infections, systemic Lupus, asthma, skin diseases and there are many others. Very often, autoimmune disease is one of the causes of multiglandular autoimmune disease, and this could be the trigger point for premature ovarian failure. This is often what brings the patients to egg donation programmes. The treatment of autoimmune diseases is not always easy—there must be a lot of communication between the immunologist, endocrinologist, diabetologist etc. The patient must also be very clearly monitored during that time, and is essential to cooperate with all the specialists. For example, thyroid function must be in the normal ranges before we start IVF and Type 1 diabetes must be perfectly controlled by the diabetologist. The treatment of other autoimmune diseases, we mostly use medication like the corticoids, low molecular weight heparins, intralipid infusions, IV immunoglobulins and so on. All these medications have their specific indications, so we must accept that there may be some side effects as a result.
There is a huge variety of antibodies which can be monitored by blood tests by the patients, and during the IVF treatment, they should be under a certain level, again, which should be monitored by the immunologist. For example, there are some Natural Killer cells, which can be taken from the peripheral blood by the patient or can be tested from uterine biopsies. So, the treatment, like I said before, is not always easy, and sometimes we must say that it’s almost impossible to treat patients with autoimmune diseases and there is really a question of the chances of getting pregnant and the outcomes of the treatment. I actually sometimes give my patients this comparison: the body is something like a computer, with software and mother, and autoimmune disease is a kind of mother—for the computer you can use some antiviral software, but for the body you cannot delete the disease, and actually the whole body has to live with this its whole life.
Answer from Dr. Rayward
Autoimmunity is a series of immune responses of an organism against its own healthy cells and tissues. The term “autoimmune disease” refers to a wide ranging group of more than 80 serious chronic diseases that involve almost every organ system. In all of these diseases, the body’s immune system is sent off course and it attacks the organs it was designed to protect. 75% of autoimmune diseases occur in women, most frequently during the childbearing years. The most common autoimmune diseases are lupus, rheumatoid arthritis, Hashimoto’s thyroiditis, Grave’s disease and Type 1 diabetes. Because abnormal immune function can affect miscarriage risk, affected women must be treated from two angles—the angle of conceiving, and the second point is to prevent pregnancy loss after conception. This is very important, because it would not make sense to get pregnant with donor eggs only to lose the pregnancy. Autoimmune diseases are not a contradiction for pregnancy per se, but sometimes uncontrollable hypertension, heart or kidney disease will lead a doctor to advise against pregnancy. One thing that is very important to tell the patients is that no more than one embryo should be transferred. It can pose great problems for the mother’s immune system if she carries a multiple pregnancy. So, once pregnant, different autoimmune disorders affect the pregnancy in different ways, for example, about two thirds of women with rheumatoid arthritis get better during pregnancy and then have a flare up of symptoms after delivery. It has also been said that it is riskier for women with autoimmune diseases to get pregnant, and it is of course true for two different reasons: one, because it can cause harm to the mother’s body, with affectations like kidney damage or hypertension, and the other danger is that sometimes the mother has an autoantibody which can harm the fetus. Autoimmune diseases are very diverse, and the best advice if you would like to fall pregnant with donor eggs, is to consult your immunologist and your fertility specialist to evaluate how safe it is for you to have a child.
Answer from Dr. Bitaine
Well, in fact, pregnancy is a special condition where a woman has to tolerate an embryo who is immunologically different from her. So, when she is using her own eggs, she will have half of the immune system different from her, the half that is coming from the father, but when we use egg donation, we have a whole new baby who is immunologically different, so this is a challenge for the body, and the immune response has to react to it. So, that’s why some women have some special difficulties to get pregnant, because of their immune response to the pregnancy and the challenge of having this embryo getting inside their body. So, that’s why women with immunological diseases may have some problems when getting pregnant or trying to do IVF treatment – that doesn’t mean all of them will have this problem, but it’s important to settle down all the situations before, to check the treatment, to check their immune response before doing treatments. It may give us some problems during the IVF treatment or afterwards, during the pregnancy – these pregnancies have to be checked by a specialist and they may need some adjustment for their immunological treatment, and it’s important to know this when starting IVF, especially when using egg donation programmes. In fact, the more embryos we transfer to the woman, the higher the immune exposure is, so that is why single embryo transfers are becoming a more important challenge with women with immunological problems.