The Use of Combined Heparin/Aspirin and Immunoglobulin G Therapy in the Treatment of In Vitro Fertilization Patients With Antithyroid Antibodies

PROBLEM: To compare the effect of heparin/aspirin therapy alone vs. heparin/aspirin in combination with intravenous immuno-globulin (IVIg) immunotherapy on in vitro fertilization (IVF) outcome of patients who test positive for antithyroid antibodies (ATAs). METHOD OF STUDY: Eighty-two women younger than 40 years of age whose infertility was related exclusively to female causes were evaluated. All tested positive for organ-specific antithyroid antibodies (antimicrosomal and/or antithyroglobulin antibodies), but negative for antiphospholipid antibodies. Thirty-seven of these women (group A) received H/A alone, whereas 45 (group B) received heparin/aspirin in combination with IVIg. RESULTS: Ten (27%) of women in group A and 23 (51%) of women in group B achieved live births after completion of a single IVF/embryo transfer cycle (P = 0.027). CONCLUSION: We conclude that IVIg therapy significantly improves IVF success rates in ATA+ women.     

Immunology: Organ-specific autoantibodies are possible markers for reproductive failure: a prospective study in an in-vitro fertilization--embryo transfer programme

This study was conducted to investigate the usefulness of organ-specificautoantibodies as possible markers for reproductive failure.Antithyroid and antiovarian autoantibody concentrations weremeasured in 78 patients with mechanical or unexplained infertilitythat were enrolled in an in-vitro fertilization (IVF)/embryotransfer programme with follow-up of the outcome. In all, 16patients (20.5%) were positive for antithyroid antibodies, nine(11.5%) were positive for antiovarian autoantibodies and two(2.6%) were positive for both autoantibodies. All 23 patientswho were positive for either antithyroid or antiovarian autoantibodies,or both, were defined as the study group, and 55 who were negativefor autoantibodies were considered as the control group. Nostatistical difference in the incidence of autoantibodies wasfound between the patients with mechanical infertility and thosewith unexplained infertility. No differences were found in themean number of oocytes retrieved, fertilization rates or meannumbers of transferred embryos between the study and the controlgroups. The pregnancy rate per cycle was 10.8% (7/65) in thestudy group, compared with 25.0% (24/96) in the control group(P<0.05). We conclude that organ-specific autoantibodiessuch as antithyroid and antiovarian antibodies may serve aspossible markers for reproductive failure. Further investigationis required to understand the possible immunopathological mechanismfor reproduction failure in patients with organ-specific autoantibodies.     

Anti-Endometrial Autoantibodies in Women with a Diagnosis of Infertility

PROBLEM: The purpose of this study was to investigate the frecuency of anti-endometrial antibodies (AEA) in infertile women. METHOD OF STUDY: Sera from fertile women (n = 6), and from patients with ovulatory dysfunction (n = 11), tubal obstruction (n = 9) and unexplained infertility (n = 5) were investigated for the presence of anti-endometrial membrane antibodies. We used two human endometrial cancer cell lines and human endometrial cells from gynecological biopsies as an antigenic source for analysis. The immunoenzymatic assay (ELISA) was performed with cultured endometrial cells in monolayers. Immunoblot analysis was performed with these two cell lines. RESULTS: A good correlation between the response with each cell line and with human endometrial cells was obtained, indicating that the antigens analyzed were probably similar. Endometrial antibodies were detectable in a high percentage of women with tubal obstruction (77.8 and 66.7%, respectively) and ovulatory dysfunction (54.5 and 45.5%, respectively). Unexplained infertility showed anti-endometrial immunological response (40 and 60%, respectively). Some endometrial antigens in infertile women are the target for autoimmune response. The serum from a patient with tubal obstruction and ovulatory dysfunction showed two antigens by immunoblot, with molecular weights of 97 and 50 kDa. CONCLUSION: The presence of anti-endometrial antibodies, detected by ELISA, is associated with infertility, mainly with ovulatory dysfunction and tubal obstruction. Some endometrial antigens may be involved in these two pathologies.     

Autoimmunity in vitiligo: relationship with HLA, Gm and Km polymorphisms.

Eighty-six patients affected by vitiligo were investigated for Gm, and Km polymorphisms, HLA markers and the presence of organ and non organ-specific autoantibodies. Vitiligo patients had an increased frequency of autoantibodies (71%), in particular anti-parietal cells (26.6%), antithyroglobulin (24.4%) and antithyroid microsomal antibodies (43%). One patient was also affected by Hashimoto's thyroiditis, 4 by Graves' disease and two others by nontoxic, multinodular goiter. No correlation was found between chronologic age and sex and the presence of autoantibodies, while an increased frequency of organ-specific autoantibodies was found with longer duration of vitiligo. HLA-A3 and Gm (3; 23; 5, 10, 11, 13, 14) phenotype frequencies were significantly increased in patients without autoantibodies (P less than 0.05). Patients negative for these two phenotypes were significantly more prone to develop autoantibodies than those positive (P = 0.0032). C4AQO allele showed a significantly decreased frequency in the whole group of patients when compared to the controls (P less than 0.05).     

Autoantibody panel screening in recurrent miscarriages

PROBLEM: Antiphospholipid autoantibodies (aPL), antithyroid antibodies and anti-extractable nuclear antigens (anti-ENA) have all been reported to be associated with recurrent miscarriages (RM) and infertility. However, this association remained controversial. MATERIALS AND METHODS: Fifty-eight women with impaired fertility (38 women with RM and 20 women with infertility, but no miscarriages) and 28 control parous women were screened for seven autoantibodies [antithyroglobulin (aTG), antithyroid peroxidase (aTPO), anticardiolipin (aCL), antiphosphatidyl-serine (aPS), antiprothrombin antibodies (aPT), anti-beta 2 glycoprotein 1 (abeta2GP1), and anti-ENA]. There was no evidence for autoimmune diseases in the patients or the control. The analysis was also performed with several panels of autoantibodies, each of which contained two or more autoantibodies. RESULTS: Anti-TPO was the only antibody to be associated with RM (P = 0.01). A significant association was found between RM, and autoantibodies in the 'aTG + aTPO + anti-ENA' or 'aTG + aTPO' panels. The 'aTG + aTPO + anti-ENA' panel was also associated with RM when the analysis was performed only on 17 women who had secondary infertility: 10 from the 38 women with RM, and seven from the 20 women with infertility and no miscarriages. A significant association (P < 0.001) was also apparent between anti-CL and anti-PS and infertility compared with the 28 control women. CONCLUSIONS: RM was associated with autoantibodies to aTPO and the combined panel of aTPO, aTG and anti-ENA, but not with aPL. aPL were associated with infertility.     

The possible role of antiovary antibodies in repeated in vitro fertilization failures

PROBLEM: The study was conducted to investigate the possible role of circulating ovarian autoantibodies (ov-ab) in patients with repeated in vitro fertilization embryo transfer (IVF-ET) failure and to evaluate the effectiveness of immunosuppression treatment in these patients. METHOD OF STUDY: The study group comprised 80 IVF patients who had five or more failed treatment cycles (mean 10.2; range 7-22). The presence of ov-ab was compared between these women and 1) 50 IVF patients who conceived during the first three treatment cycles; 2) 50 healthy nulligravidae. All participants were seronegative to nonorgan-specific and antithyroid autoantibodies. Patients in the study group who were positive for ov-ab were treated with 10 mg/day prednisone starting 1 month before ovulation induction. Embryo grading was compared in the IVF cycles before and after treatment. RESULTS: Ov-ab were found in ten patients (12.5%) in the study group, compared to none in the control groups (P = 0.01). Nine of the patients positive for ov-ab were treated with prednisone for their following cycle. A statistically significant improvement in embryo grading was noted. Three patients conceived after treatment (33%), with a take-home baby rate of 22%, compared to only six patients (8.6%) who conceived among the rest of the seronegative study group, with a take-home baby rate of 7.1% (P = 0.05). CONCLUSIONS: Ov-ab are a possible marker of an autoimmune disorder that may be one of the causes of repeated IVF failures. Immunosuppression treatment may prove efficient in ov-ab seropositive patients with repeated IVF failures by improving embryo grading and pregnancy rate.     

Serum levels of thyroid-stimulating hormone receptor antibodies during IFN-alpha2a treatment of chronic hepatitis C.

Twenty chronic hepatitis C patients with baseline levels of thyroid hormones, antithyroglobulin, and antimicrosomal antibodies within the normal range were monitored by thyroid testing during a 26-week treatment with interferon-alpha2a (IFN-alpha2a). The present study was aimed at retrospectively analyzing thyroid-stimulating hormone (TSH) receptor antibodies, employing stored serum samples obtained from these patients at baseline, at 12 weeks, and at the end of IFN-alpha2a treatment. Ten patients (group A) received IFN-alpha2a at a total dose of 474 million units (MU), and 10 patients (group B) at a total dose of 774 MU. None of the patients produced antithyroglobulin and antimicrosomal antibodies. Two patients in group A exhibited elevated TSH levels without free thyroid hormone alterations while on the treatment. At baseline, 1 patient in group A had a positive TSH binding inhibitory immunoglobulin, and 1 patient in group B was positive for thyroid-stimulating antibody at the end of treatment. Both patients remained euthyroid throughout the treatment. Treatment with IFN-alpha2a may infrequently induce the production of TSH receptor antibodies in chronic hepatitis C patients provided preexisting autoimmune thyroid disease is precluded.     

Fertilization rate in couples with unexplained infertility.

A group of 24 couples with unexplained infertility was scheduled for in-vitro fertilization and tubal embryo transfer between May 1989 and September 1990. In the same period, in-vitro fertilization and intrauterine transfer of embryos was planned in a control group of 44 women with tubal infertility. The mean age and duration of infertility were similar in both groups and the same scheme of ovarian stimulation was used. No statistically significant difference was obtained comparing oestradiol levels and numbers of mature oocytes retrieved between the group of patients with unexplained infertility and those with tubal infertility. The fertilization rate of the oocytes obtained from women with unexplained infertility (60.4%) was significantly lower (P less than 0.001) than that of the oocytes obtained from patients with tubal infertility (87.3%). There was no statistically significant difference in the cleavage rates between patients with unexplained infertility and those with tubal infertility. It is concluded that lack of fertilization is an unexplored cause of infertility in couples with unexplained infertility.     

High Levels of Anticardiolipin Antibodies in Patients with Abnormal Embryo Morphology Who Attended an In Vitro Fertilization Program

PROBLEM: Recently, it has been suggested that anticardiolipin antibodies (ACAs) may serve as possible markers for reproductive failure. The association between ACAs and embryo morphology in patients undergoing in vitro fertilization (IVF) was investigated. METHOD OF STUDY: This prospective study comprised 117 patients with either tubal factor or unexplained infertility. Embryo morphology was blindly scored from I to IV according to blastomere regularity and the presence of fragments. Anticardiolipin antibodies (immunoglobulin [Ig] G and IgM) were detected. RESULTS: Anticardiolipin antibodies were found in 26 (50%) of the 52 patients with abnormal morphology, compared with 13 (20%) of the 65 patients with normal embryo morphology (P = 0.001). No statistically significant differences were found between the prevalence of ACAs among patients with tubal factor and those with unexplained infertility (29.6% and 36.5%, respectively). CONCLUSIONS: Our study shows an association between embryo morphology and the presence of ACAs. This association may explain the low implantation rate and early pregnancy loss in patients with ACAs.     

Autoantibody disturbances in affective disorders: a function of age and gender?

BACKGROUND: Numerous investigators have reported increased autoantibodies to a wide variety of native antigens in patients with affective disorders. However, association of autoimmunity with affective subtypes, mood state, psychotropic medications, age, and gender has not been extensively explored. METHODS: The present study assessed 79 bipolar I, 24 bipolar II, and 46 unipolar major depression patients along with 22 healthy, nonpsychiatric controls for the presence of serum antinuclear (ANA), anti-double stranded DNA, antithyroid microsomal, antithyroglobulin, anticardiolipin (ACA) IgM, and ACA IgG antibodies. RESULTS: Consistent with their higher prevalence of autoimmune disease, women exhibited increased levels of ANA and ACA IgM compared to men. ACA IgG antibody titers also increased significantly with age. Contrary to prior reports of general, overall increases in autoantibodies and specific increases in ANA and antithyroid antibodies in depressed patients, we did not see a significant association between any of the autoantibodies and affective subtype, mood state, or psychotropic medications. LIMITATIONS: Affective subgroups were heterogeneous with respect to psychotropic medications, affective state, age, and gender in this retrospective analysis. Subgroup sample size was insufficient to determine whether interactions of these clinical variables may have influenced results. CONCLUSION: These results suggest that gender and age may have more influence on autoantibodies than affective diagnosis, affective state, or medications.     

Autoantibodies in chronic idiopathic urticaria and nonurticarial systemic autoimmune disorders

BackgroundChronic idiopathic urticaria (CU) has been associated with other autoimmune diseases and basophil-activating autoantibodies to FcεRI or IgE. It is unknown whether patients with systemicautoimmune diseases have a similar prevalence of these autoantibodies.ObjectiveTo compare the prevalences of basophil-activating autoantibodies (elevated CU Index) in patients with CU, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Clinical characteristics and laboratory studies were examined for an association with the CU Index.MethodsAdult patients, 27 with CU, 27 with RA, and 26 with SLE, and 20 healthy controls were compared on the basis of the CU Index panel, anti-IgE, and antithyroid antibodies.ResultsThe CU Index values were significantly higher in the CU group when compared with the RA group but not when compared with the SLE group. 33% of CU, 23% of SLE, 3.7% of RA, and 15% of controls had apositive CU Index. Elevated antithyroid antibody levels did not correlate with a positive CU Index in any of the groups. An elevated CU Index in the SLE group was not associated with age, sex, ethnicity, disease severity, or history of atopy.ConclusionThe CU Index values were elevated in patients with CU and SLE. The presence of these autoantibodies did not correlate with disease activity or presence of thyroid antibodies. Functional autoantibodies may not be specific for chronic idiopathic urticaria, and their role in nonurticarial systemic autoimmune diseases requires further investigation.     

Influence of Antithyroid Antibodies in Euthyroid Women on In Vitro Fertilization-Embryo Transfer Outcome

PROBLEM: To investigate whether antithyroid antibodies (ATAs) affect the pregnancy outcome in euthyroid women undergoing in vitro fertilization-embryo transfer (IVF-ET). METHOD OF STUDY: Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody (TGA) were measured by radioligand assay kits that were used as ATAs in 79 patients with tubal or unexplained infertility who were enrolled in an IVF-ET program. Women who were positive for antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, and rheumatoid factor were excluded from our study. The study group comprised 28 (29.1%) euthyroid women who were positive for TPOAs, TGAs, or both. Fifty-one euthyroid women without ATAs served as control subjects. The results were analyzed with linear regression analysis, Student's f-test, Mann-Whitney U test, Kruskal-Wallis analysis of variance, χ² test, and Fisher's exact test. RESULTS: There were no significant differences between the study group and the control group in patient characteristics such as age, infertility duration, and hormonal profile. There were also no significant differences between the two groups with respect to the number of retrieved oocytes, the fertilization rate, the number of embryos frozen, and the number of embryos transferred. There were no correlations between ATA (TPOA and TGA) titers and the fertilization rate. The clinical pregnancy rate per cycle was significantly lower in the study group, with 26.3% (10/38), compared with 39.3% (35/89) in the control group. The biochemical pregnancy rate per cycle and the miscarriage rate were significantly higher in the study group, 18.4% (7/38) and 40.0% (4/10), respectively, compared with 5.6% (5/89) and 11.4% (4/35), respectively, in the control group. In the study group, both TPOA and TGA titers were significantly higher in the biochemical pregnancy group than in the clinical pregnancy group or the nonpregnancy group. In 10 women with ATAs who achieved pregnancy after IVF-ET, both TPOA and TGA titers were significantly higher in the miscarriage group than in the ongoing pregnancy/delivery group. CONCLUSION: ATAs in euthyroid women with tubal or unexplained infertility have an association with a poor pregnancy outcome after IVF-ET treatment.     

Putative predictors of antibodies against follicle-stimulating hormone in female infertility: a study based on in vitro fertilization patients

PROBLEM: We have previously demonstrated the presence of naturally occurring antibodies against follicle-stimulating hormone (FSH) in patients with endometriosis and polycystic ovary syndrome (PCOS). Here, we investigated the parameters associated with anti-FSH antibodies in in vitro fertilization (IVF) patients. METHODS OF STUDY: The following parameters were studied in 135 patients: peripheral FSH levels, FSH beta-subunit gene (FSHB) haplotypes, history of previous IVF, and susceptibility to autoimmune reactions in general [seven common autoantibodies (against nuclear antigens on human and rodent substrates, smooth muscle, gastric parietal cells, beta2-glycoprotein I, cardiolipin, and thyroid peroxidase) and HLA-DQB1 alleles]. RESULTS: Although the anti-FSH levels were higher in patients when compared with controls, those higher levels were not associated with FSHB haplotypes. The anti-FSH IgM associated with (i) the levels of FSH in women with male and tubal factor infertility; (ii) the history of IVF in patients with PCOS, endometriosis, and unexplained infertility; and (iii) the production of common autoantibodies among all IVF patients. The anti-FSH IgA associated with HLA-DQB1*03. The anti-FSH IgG correlated with the values of anti-FSH IgA and IgM. CONCLUSION: Anti-FSH may be naturally occurring antibodies associated with peripheral FSH concentrations, but increased in infertile women with dysregulation of immune reactions and repeatedly performed IVF.     

Association of unexplained infertility with gonadotropin and ovarian antibodies

PROBLEM: To determine the prevalence and characteristics of gonadotropin autoantibodies (GAB) associated with unexplained infertility, and to assess the relationship between ovarian autoantibodies (OVAB) and GAB. METHOD OF STUDY: Ovarian antibodies and GABs in sera of patients with unexplained infertility (n = 53) and a comparison (population) group from a blood bank (n = 40) were detected by immunoassay. Patients with unexplained infertility had either no prior gonadotropin treatment (n = 15) or two or more gonadotropin cycles to induce ovulation (n = 38). RESULTS: The GABs were detected in 67% of women with treatment, 27% of women without treatment and 8% of women in the population. The GABs recognized follicle stimulating hormone (FSH) and luteinizing hormone (LH) and their alpha and beta subunits and to a lesser extent thyroid stimulating hormone (TSH) and prolactin. There was no significant difference in OVAB prevalence between gonadotropin treated or untreated women while GABs were significantly more frequent in gonadotropin treated women (P < or = 0.01). CONCLUSION: Gonadotropin antibodies may represent a separate marker of ovarian autoimmunity in unexplained infertility as they are correlated with OVAB and are present in patients not treated with gonadotropin. However, as a higher frequency of GAB is associated with gonadotropin treatment, patients with ovarian autoimmunity may tend to have an immune response to gonadotropins in addition to an endocrine response.     

Studies on the immunoregulation of thyroid autoantibody production in vitro.

The spontaneous production (without mitogen or antigen) of antithyroglobulin and antimicrosomal antibodies by peripheral (PBL) and thyroid-derived lymphocytes from patients with Hashimoto's thyroiditis (HT) has been studied with particular emphasis on the regulation of this phenomenon. Based on studies of DNA and protein synthesis, kinetic studies and B/T reconstitution experiments, in most HT patients, spontaneous production by PBL is accounted for by secretion of preformed antithyroglobulin (termed Type 1 patients), whereas active production is observed in a small minority (termed Type 2). In none of 24 HT patients could active antimicrosomal antibody production by PBL be detected. Conversely, thyroid-derived lymphocytes produced both autoantibodies by an active process. Pokeweed mitogen (PWM) stimulation enhanced antibody production by PBL in the Type 1 group but not in Type 2 or thyroid-derived lymphocytes. T lymphocytes were required for antibody synthesis in both thyroid antigen-driven and peripheral PWM-driven cultures. By separating T lymphocytes into T4+ (helper) and T8+ (suppressor) subsets with monoclonal antibodies, T-cell modulation of autoantibody production in both systems was studied. In a PWM-induced system, both thyroid and peripheral T-cell subsets were capable of modulating peripheral antibody production. In the thyroid lymphocyte antigen-specific system, further addition of thyroid derived T8+ cells alone caused partial suppression of antibody production but not with peripheral T8+ cells. Of interest was the partial decrease of antibody production by the thyroid lymphocytes by added peripheral T4+ cells. The fact that the production of thyroid autoantibodies by thyroid-derived mononuclear cells (which included T suppressor, T helper and B lymphocytes) could be reduced by the addition of more suppressor T lymphocytes suggests that an antigen-specific defect in the T4+/T8+ thyroid cell balance may account for the in vivo production of these antibodies in patients with Hashimoto's thyroiditis.     

Natural cycle IVF in unexplained, endometriosis-associated and tubal factor infertility.

BACKGROUND: To elucidate possible differences between unexplained and minimal peritoneal endometriosis-associated infertility, we studied their outcome in natural cycle IVF (NIVF). METHODS: A prospective cohort study was carried out on unexplained (33 couples), minimal peritoneal endometriosis-associated (30 couples) and tubal factor (24 couples) infertility in 223 NIVF cycles, using human chorionic gonadotrophin (HCG) for ovulation induction. RESULTS: During the first NIVF attempt, follicular and luteal phase oestradiol, FSH, LH and progesterone concentrations, as well as endometrial thickness and follicular diameter were similar among the three groups. Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility. The fertilization rate, clinical pregnancy rate per initiated cycle, per successful oocyte retrieval and per embryo transfer, in minimal endometriosis (80.0, 10.4, 16.0 and 23.5% respectively) were similar to that in tubal factor infertility patients (68.6, 5.8, 11.4 and 16.0%) but significantly higher (P < 0.05) than that of the unexplained infertility group (62.2, 2.6, 5.4 and 8.7%). CONCLUSIONS: The significant reduction in follicular periovulatory growth, fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality, intrinsic embryo quality factors or by impaired implantation. From a clinical point of view, NIVF is less suited to unexplained infertility treatment, but might represent an interesting treatment option for minimal peritoneal endometriosis-associated infertility.     

Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility

BACKGROUND: This study was undertaken in order to compare pregnancy outcome after IVF and ICSI in unexplained and endometriosis-associated infertility using tubal factor infertility as controls. METHODS: This was a retrospective cohort study of early IVF/ICSI pregnancies verified by serum hCG measurement, comparing the subsequent outcome in unexplained (n = 274) and minimal endometriosis-associated (n = 212) with tubal factor (n = 540) infertility as controls. From January 1990 to December 2002, 1026 conception cycles after treatment with IVF or ICSI complied with the inclusion criteria. RESULTS: Live birth rate, twin birth rate after transfer of two embryos and abortion rate prior to 6 weeks of gestation were superior for the unexplained (78.8, 23.5 and 11.7%) compared to endometriosis-associated (66.0, 15.0 and 19.3%) and tubal factor (66.7, 18.1 and 18.0%) infertility groups (P < 0.05). Compared to the endometriosis-associated, the unexplained infertility group attained a higher pregnancy rate after the first treatment cycle (P < 0.05). CONCLUSIONS: The overall better outcome for the unexplained infertility group with respect to live birth rate, twin birth rate and early abortion rate compared to the minimal peritoneal endometriosis-associated and tubal factor infertility groups might be a guide to select diagnostic groups for single embryo transfer and be useful in patient counselling.     

Enzyme-linked immunosorbent determination of autoantibodies to zona pellucida as a possible cause of infertility in women

An enzyme-linked immunosorbent assay (ELISA) for determination of antibodies against the zona pellucida was developed and compared with the already available indirect immunofluorescence (IIF) technique. Sera from 100 women with explained and unexplained infertility were screened for the presence of autoantibodies to the zona pellucida by ELISA and IIF techniques. Porcine/goat zonae immobilized on activated microtitre plates or solubilized zona pellucida antigens adsorbed on poly-L-lysine-coated microtitre plates were used as a solid phase in an ELISA. Assay of anti-zona pellucida antibodies in xenogeneic and allogeneic sera was performed by incubation of test samples with the solid phase against human serum supplied by WHO as a reference positive control, followed by incubation with staphylococcal protein A conjugated to horseradish peroxidase. The ELISA was effectively used to screen the production of monoclonal antibodies from mouse myeloma X mouse splenocyte hybridomas. The sensitivity of the ELISA was more than 2500-fold greater than that of the IIF technique. Significantly high titres of autoantibodies to zona pellucida were found in patients with unexplained infertility as compared with patients with a known cause of infertility, and their normal counterparts.     

Retrograde tubal embryo transfer in natural cycle in-vitro fertilization

Two modes of embryo transfer, uterine and tubal, were compared following natural cycle in-vitro fertilization (IVF). Only patients with patent Fallopian tubes were included in the study. Tubal embryo transfer was performed by retrograde tubal cannulation without analgesia on an outpatient basis. Tubal transfer conferred no benefit compared with uterine transfer in male factor infertility with positive fertilization (pregnancy rates of 15.8% in both groups). Although tubal embryo transfer in the patients with unexplained infertility improved the pregnancy rates from 7.8% in uterine transfer (5/64) to 17.6% in the tubal transfer group (13/74), this improvement was not statistically significant.      

Anti-Seminal Plasma Antibodies Associated With Infertility: I. Serum Antibodies Against Normozoospermic Seminal Plasma in Patients With Unexplained Infertility

PROBLEM: To determine whether patients whose infertility remains unexplained (by routine physical and laboratory investigations including sperm antibody testing) exhibit significantly elevated humoral anti-seminal plasma immune responses in comparison to fertile individuals. METHOD: Sera from 72 infertile couples were examined by ELISA for the presence of antibodies against normozoospermic seminal plasma (NSP). A group of 36 fertile individuals was used to determine the level of physiological reactivity. Kibrick's and Friberg's sperm-agglutination tests were employed to distinguish patients routinely diagnosed as immunologically infertile. RESULTS: Anti-NSP reactivity was elevated in 18% of male and 26% of female patients. In the female patients, the prevalence rate for elevated anti-NSP reactivity was significantly higher among partners of positive men. In only 4% the positive anti-NSP results coincided with sperm-agglutinating antibodies. CONCLUSION: NSP constituents other than sperm-coating antigens might interfere with infertility related autoimmune imbalance. The identification of the corresponding NSP antigens might help to resolve more cases of unexplained infertility.