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Infertility is the inability to conceive after at least a year of trying, and is a condition that around 1 in 6 couples suffer from during somehow in their lives. When couples have trouble conceiving for a long time, they always look for a cause and diagnosis and do several tests to solve their problem with infertility doctors. In some cases, the causes of infertility may still be unknown, which confirms the diagnosis of “unexplained” infertility.

A medical appointment

“Your Health” met Professor Dr. Imad Abdel Qader Koshak, Consultant in Internal Medicine, Allergy and Clinical Immunology, Department of Internal Medicine – College of Medicine – King Abdul Aziz University in Jeddah, to learn from him about “reproductive immunology”, as the pioneer of this branch of medicine in the Kingdom, and her role in treating immunological infertility in women.

Dr. Koshak explained that reproductive immunology is a new, precise medical science that focuses on how the immune system interacts with the various organs in a woman’s reproductive system. temporarily releasing an egg and then fertilizing it with sperm during pregnancy. It is a modern, rare and complex science that aims to determine whether the mother’s immune system is prepared to accept a pregnant fetus and prevent this foreign body (to level) from the woman’s womb.

As for the doctor who specializes in reproductive immunology, he is a consulting doctor who especially understands the role of the immune system in fertility and pregnancy in clinical immunology, followed by a certificate certified in reproductive immunology, after an additional training period.

Unexplained infertility

Professor Koshak explained that medical research indicates that the rate of “unexplained infertility” could reach 30 percent of infertility cases. A woman is diagnosed with unexplained infertility if she is unable to conceive after one year of trying and no defect is found in the reproductive systems. This means that all fertility tests show normal results, and there is no explanation why pregnancy does not occur.

The relationship between immunity and pregnancy

Many patients and doctors wonder about the relationship between immunity and pregnancy success or failure.

AD: Koshak replied: A failed pregnancy is either caused by a failure to produce a pregnancy or a failure to complete it until a live child is born with full organs and development. The presence of a healthy and balanced immune system is essential for pregnancy to occur and continue, as natural immune cells play an important role in helping the endometrial cells to accept, culture , and nourishes the cells of the fetus. The immune system is also responsible for stimulating the growth of certain essential blood capillaries that are important in the formation and development of placental cells to facilitate the healthy growth of the fetus.

If there are disorders or weakness in the immune system, this will not allow it to support pregnancy.

Some women may experience obstacles in the early stage of implantation of an embryo in the uterine line, as the cells of the natural immune system perceive it as a foreign body. the embryo first because half of its genetic components are inherited from the father. But soon the mother’s immune system begins to use its natural function and recognize the cells of the fetus and then contain and protect this fetus from any attack from other foreign bodies.

But this situation is very different among women who suffer from various immune system problems, because the immune system does not succeed in recognizing the fetus from the beginning, but begins to attack on and destroys, causing cases of pregnancy failure or recurrent pregnancy loss.

Methods of diagnosis

Prof. Dr. Imad Koshak Some of the techniques and methods that reproductive immunologists can use to help women with unexplained or unknown infertility are:

> For clinical examination to diagnose immune diseases: The reproductive immunology consultant takes a careful medical history and clinical examination to detect immune diseases that may cause unexplained infertility in women. The most important of them are autoimmune diseases, which are specific pathological conditions in which the immune system attacks healthy cells and tissues in the body by creating antibodies against them, as if are foreign and abnormal cells. Because of these antibodies, a woman can suffer several symptoms in her body, and in many cases they can be hidden, that is, without symptoms.

The most common autoimmune diseases that can interact with fertility and reproductive cells and organs are antiphospholipid syndrome, immune thyroid disorders, rheumatic diseases associated with antinuclear antibodies, immune digestive system diseases, and others another.

> Immune laboratory tests: The reproductive immunology consultant may order a group of special laboratory tests to detect cases of immune system problems. The most important of these are tests for autoimmune antibodies: antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, gastrointestinal antibodies, antiovarian antibodies, and antiperm antibodies. General inflammatory markers and levels of immunoglobulins are also examined. Then study the activity of lymphocyte immune cells such as helper, toxic and inhibitory T cells, B cells, and natural killer cells. Several special studies are also carried out to evaluate blood fluidity, which is considered one of the factors that lead to poor blood circulation and insufficient perfusion of the ovaries, uterus, and fetuses, which ‘ causes recurrent pregnancy failure.

Treatment plans

> Developing an integrated treatment plan: with a reproductive immunology consultant, specially designed to meet the needs of women suffering from immunological infertility and according to the type of immune problem It gives a – include a group of treatments to suppress the immune system or modify the immune response such as: salicylic acid (aspirin), immunosuppressive medications (such as cortisone), hydroxychloroquine, azathioprine, etc.), intravenous lipotherapy, and immunotherapy with immunoglobulin intravenous.

> Monitoring cases of recurrent pregnancy failure: The reproductive immunology consultant may order several laboratory tests to determine whether immune factors contribute to the following pathological conditions: miscarriage recurrent, recurrent pregnancy loss, stillbirth, and premature birth. He or she can recommend appropriate immunotherapeutic interventions to improve the chances of a successful pregnancy.

> Monitoring cases of repeated insemination failure: Assisted reproductive methods are used to overcome some contraceptive barriers, including: intrauterine insemination (IUI), where sperm is injected directly into the uterus, or in vitro fertilization (IVF), where a single sperm is injected. directly into the uterus inside the egg under the microscope (ICSI). In cases where repeated insemination failure is unexplained, the reproductive psychologist will find any immunological reasons for this and treat them before the next artificial insemination process.

> Prefertility consultations: A reproductive immunology consultant can provide prenatal consultations for women with known immune disorders or a history of recurrent fertility problems and unexplained delayed childbearing, and also advise over developing a healthy immune system a few months before she gets pregnant. reduce the risk of immune-related complications during pregnancy. A natural pregnancy can occur during this treatment period due to the constant over-activity of immune cells, even while waiting for artificial insemination.

> Collaboration and teamwork with other specialists: A reproductive immunology consultant often works closely with other fertility and infertility specialists, including infertility OB-GYNs, reproductive endocrinologists, and andrologists to provide comprehensive care for women with unexplained infertility. This approach ensures that there is a multi-specialist interest in treating all aspects of fertility and pregnancy.

Practical knowledge

Here is Dr. Dr. Imad Koshak, based on his practical experience over the years, as a consulting physician in the specialty of internal medicine, allergy and clinical immunology, has examined a large number of women who have suffered from infertility unexplained for many years. They were put forward by a group of professors and consultants of obstetrics, gynecology and infertility who were convinced of the importance of the role of the immune system in the success or failure of pregnancy and childbirth. At the head of these professors is Dr. Samir Abbas, a pioneer of in vitro fertilization in the Arabian Gulf.

After clinical examination and several specific and accurate laboratory studies and analyses, several possible causes of immune disorders and several types of autoantibodies were investigated, which were published in international medical journals. nationally peer-reviewed. These virtuous women were prescribed and used treatments and supplements to regulate the functions of the immune system, which, thanks to God, led to successful pregnancy outcomes and healthy child births.

We cannot fail to praise the generous support of the state, as well as the efforts of the Ministry of Education which are consistent with the ambitious vision. who returned to their home country from outside the Kingdom after completing their studies and training and obtaining internationally accredited qualifications in Specialization in reproductive immunity.

In conclusion, consultants specializing in clinical and reproductive immunology play an important role in the diagnosis, treatment, and management of systemic disorders. maternal protection, which contributes to solving the problems of chronic infertility and unexplained delayed childbirth. This will help in achieving a successful pregnancy, healthy children, and will bring happiness to all married and childless people.

* Community therapy consultant