“When there is breakdown in the mother’s immune system … it is more than likely that the embryo will have a problem protecting itself from the maternal immune system” – something so simple and yet often overlooked. According to Dr. Jeffrey Braverman, a leading reproductive immunologist, both maternal and paternal autoimmune disease and general immune system dysfunction play prominently in infertility and recurrent pregnancy loss, and yet, very rarely are these conditions considered against that backdrop.
Maternal Immune Function, Infertility and Recurrent Pregnancy Loss
In the moms, his research team has identified a cluster on autoimmune haplotypes or genetic fingerprints associated with infertility and recurrent miscarriage that include several patterns of HLA genes associated with common autoimmune diseases. HLA genes code for the human leukocyte antigens called major histocompatibility complexes, the immune cell molecules that guide the activity of our immune reactions. The HLA haplotypes or patterns Dr. Braverman’s group found associated with recurrent pregnancy loss include those for: Hashimoto’s disease, lupus, multiple sclerosis, antiphospholipid syndrome, Sjogren’s syndrome, scleroderma and autoimmune hepatitis.
Frequently, the moms also have endometriosis and sometimes even asymptomatic endometriosis, or what he calls, silent endometriosis. While the connection between symptomatic endometriosis and infertility is clear, the notion that endometrial implants are present but causing no symptoms except infertility is a novel one. Research in rodent models of endometriosis suggests that the neither presence nor size of endometrial implants necessarily confers pain. Rather, it is the location of the growth and more specifically, whether the endometrial implants contain nerve fibers that determine whether there is pain. Dr. Braverman’s discovery of a silent endometriosis may support that finding.
More importantly, Dr. Braverman contends the autoimmune nature of endometriosis and specifically, the intra-abdominal inflammatory cytokines and the over-production of mitochondrial reactive oxygen species (ROS), may act to deactivate sperm and must be corrected before pregnancy will take place.
“The autoimmune nature of endometriosis can affect egg quality by elevating the intra-abdominal levels of inflammatory cytokines that the ovaries are directly exposed to. This causes a condition known as oxidative stress and raises the level of a “toxic” chemical called ROS (reactive oxygen species) that the eggs are exposed to. (This can be treated to improve egg quality). In fact in IUI cycles or in patients trying to conceive on their own, these same ROS molecules can essentially deactivate the sperm sometimes requiring IVF even when there are no signs of tubal blockage.”
More often than not, the women who seek treatment with Dr. Braverman have been seen by other reproductive specialists who disregarded the immune dysfunction as contributing to infertility or recurrent pregnancy loss. Thyroid function, in particular, plays a large role in maternal and embryo health and is one of the most commonly disregarded culprits of infertility and recurrent pregnancy loss. As thyroid receptors are located on the follicle and thyroid antibodies have been identified in the follicular fluid, especially with PCOS, small perturbations in thyroid concentrations will affect the growth, quality of the follicles and one’s overall ability to conceive. Additionally, since thyroid hormones directly impact mitochondrial functioning and dysfunction or ROS production, it makes sense that identifying and treating thyroid disease would be imperative for healthy pregnancy.
Thyroid Disease and Recurrent Pregnancy Loss
Identifying and correcting immune dysfunction is critical to promote conception and pregnancy. Commonly, this involves a specific set of supplements targeted towards the patient’s particular type of immune dysfunction.
Supplements for Infertility and Recurrent Pregnancy Loss
Paternal Health: Dad’s Role in Recurrent Miscarriage
More often than not, dad’s health is ignored once conception takes place. It is believed that once a woman becomes pregnant, dad’s contribution is no longer important and the remainder of the pregnancy is solely her responsibility. Not so, says Dr. Braverman. Dad’s health, dad’s immune system health and compatibility with mom’s immune system are large contributors to whether the pregnancy is sustained or miscarried. Dad’s immune function determines sperm morphology or shape. Even slightly askew sperm have difficulty with motility and mobility, egg penetration and/or can contain fragmented DNA, which will then evoke miscarriage. Moreover, chemicals in the seminal fluid interact with the mom’s immune system and determine whether she will tolerate the growing embryo. Dad’s health is critical to mom’s ability to get pregnant and stay pregnant.
Paternal Contributions to Infertility and Recurrent Pregnancy Loss
What to Do Now
If you or yours are having issues with infertility, consider correcting maternal and paternal health issues first, in advance of attempting to conceive. Reproductive immunologists and other more functional medical specialist may be able to help.
Please note, Hormones Matter has no association with Dr. Braverman’s practice. We simply appreciate his approach.
This article was published previously on Hormones Matter in July of 2014.