Reproductive immunology issues are for the most part in the domain of laboratory diagnostics. As, however, individual facts are still not unambiguously identifiable, even laboratory diagnostics have to rely on exclusion diagnostics. We use targeted tests to exclude specific factors. The first step is always the exclusion of genetic causes for infertility. That is done by way of a chromosome analysis of both partners. We are partnered with a highly reliable human genetics centre for these types of tests.
Next, we will test for possible coagulation disorders. The main point here is to recognise thrombosis risk factors, but the test will also focus on deficiencies in coagulating factors, which can lead to an increased bleeding tendency. Should the results remain unremarkable, we will then focus on immunological factors. We would like to point out here that the “transition” between coagulation disorders and immunological factors may not be clearly defined, as coagulation disorders may present even if autoantibodies and immune factors are found.
Laboratory diagnostics of possible immune-related infertility factors are categorised into two main groups:
1. Autoimmune risk factors:
The identification of autoantibodies present in autoimmune diseases. We can, of course, only test for the most common factors taking into account the patient history provided, which is of high importance in this test. There are, however, quite a few cases in which autoantibodies may exist without any clinical symptoms. Findings of autoimmune factors often include findings of a disruption of cellular immune function and immune balance.
2. Alloimmune risk factors:
These refer to a constellation with foreign antigens (properties), and therefore to the constellation with the antigens of the partner. This includes the examination of the cellular immune defence reactivity. Latest results refer in part to the significance of genetically induced immune responses, e.g. the determination of the killer cell immunoglobulin-like receptor genotype (KIR genotype).
The humoral and cellular immune function will be examined because an adequately balanced immune function is a decisive factor in a healthy pregnancy. Highly differentiated examinations will allow the pinpointing of activities of specific immune-competent cells (NK cell assay – examines the cytotoxic activity of natural killer cells). Other examinations will focus on the predominant TH1/TH2 immune situation. The test will determine the secretion performance of cytokines (immune messengers).
During the second half of each female cycle, immune-competent cells settle in the endometrium. This process is largely controlled by immune-tolerant NK cells. Taking a small tissue sample during the second half of the female cycle will allow testing for these conditions and cells.