Immunological infertility problem common among married couples suffering from infertility, with a frequency of 5 to 15%. The choice of treatment tactics is a difficult medical challenge, as the results of numerous studies have shown that treatment of immunological infertility is a low efficiency. It proposed several techniques that can be recommended to treat the pair after a full examination of both partners.
The use of immunosuppressive therapy
This type of therapy is used in practice to suppress the immune response, and is based on the principle of action of the drugs used. For this purpose, two groups of medicines used - glucocorticoids and NSAIDs (nonsteroidal anti-inflammatory drugs). The most common use of the glucocorticoid prednisolone group
Prednisolone - against inflammation, allergy and pain, but with complications
Methylprednisolone and dexamethasone
Dexamethasone - one of the most effective glucocorticosteroids
. They contribute to suppress generation of antibodies (ACAT or antisperm antibodies) and also affect the metabolism of immunoglobulins and interferons. To get some positive results from the therapy, the drug should be administered in very high doses. Against this background, greatly increases the risk of serious adverse reactions and complications associated with the suppression of the immune system. This should be considered in each case in dealing with the appointment of glucocorticoids for therapeutic purposes.
Regarding the use of the group of NSAIDs, such treatment is most prevalent in the 80s. Used ibuprofen, diclofenac
Diclofenac - relieve inflammation and pain
, Naproxen, indomethacin, and other drugs in this group at different therapeutic schemes. Their therapeutic effect is due to the mechanism of suppression of the immune response (or immune suppression), as well as the ability to increase sperm motility. It was shown that the percentage of positive results was low and amounted to only 15%, which was comparable to the placebo effect
Placebo - an effective tool for self-hypnosis
. At the present stage, the use of this group of drugs is clinically justified.
Lately carried out extensive studies on the effectiveness of the efferent methods and the appropriateness of their use in the treatment of immunological infertility. Using plasmapheresis facilitates removal from the bloodstream of immune complexes, which favorably affects the functional activity of the sperm. It is proved that the efferent therapy sessions to improve the fertilizing capacity of sperm, increasing it, which can be used to expand the indications during the medical treatment of male factor infertility.
What is included in the concept of contraceptive therapy
It is proved that in some cases it may be a local immune response in response to the natural flow of sperm into the female genital tract. Such a reaction is not associated with systemic response of the organism, there is a development of sperm antibodies in high concentrations only locally. There comes a woman spermatozoa immunization antigens, which can be explained by several mechanisms:
- the local immune response triggers long-term asymptomatic infection by genital or urogenital infection
- independent antibodies without any apparent reason
As a remedy for this condition prompted the couple continued use of barrier contraception or local. An average of six months to a year should be used a condom. It is very difficult to talk about how to obtain a statistically significant effectiveness of these treatments, but the contraceptive therapy can be recommended as one of the methods in the complex therapy of immunological infertility, as it allows to exclude sensitization.
Appointment of medical measures in this form of infertility is possible only with full comprehensive examination of both sexual partners and establishing the true cause of the disease. In some cases, the detection of hormonal abnormalities in immunological infertility therapy is assigned male sex hormones or androgens. Correction of the immune status using androgens can be called one of the therapeutic methods of combination therapy for infertility. When combined with other androgen treatment interventions can achieve reduction of sperm antibodies by almost 30%, which is considered a good result in this pathology. The remote is a positive pregnancy in a married couple who are being treated for infertility.
Marina Solovyov