Abstract
BackgroundIn successful reproduction, endocrine and immune systems closely interact. We here attempt to further elucidate the relationship between androgen levels, systemic activation of the immune system and reproductive success in infertile women, utilizing 2 distinct infertile patient cohorts.MethodsIn Group 1, we investigated 322 women (ages 38.6 +/− 5.4 years) at initial presentation; in Group 2 125 women undergoing in vitro fertilization (169 IVF cycles, ages 38.9 +/− 5.5 years). In Group 1, we assessed androgens and an immune panel, previously demonstrated to discriminate between activated quiescent immune systems; in Group 2, utilizing the same immune panel, we investigated whether immune system activation relates to embryo quality in IVF cycles.ResultsNo individual immune test within the immune panel was associated with androgen levels. The total/free testosterone ratio (TT/FT) was, however, significantly associated with presence of gammopathies (in IgG, IgM, IgA, IgE; P = 0.026). Surprisingly, immune system activation was associated with significantly improved embryo quality (P = 0.008), a finding persistent after adjustment for age and repeat IVF cycles (P = 0.006).ConclusionsAssociation of immune system activation with improved embryo quality concurs with previously reported immune activation in association with normal functional ovarian reserve (FOR) and normal androgen levels, while, counter intuitively, hypoandrogenism and low FOR are associated with lack of immune system activation. Mild immune system activation, therefore, likely appears essential for establishment of pregnancy, and may be regulated by androgens.
Highlights
In successful reproduction, endocrine and immune systems closely interact
We recently noted that women with low functional ovarian reserve (LFOR) at practically all ages are characterized by relative hypoandrogenism [10]
Somewhat counter intuitively, we discovered that they demonstrated no evidence whatsoever of immune system activation as we initially had hypothesized; yet, young, healthy control patients with normal androgen levels, to some degree did demonstrate evidence of immune system activation [11]
Summary
We here attempt to further elucidate the relationship between androgen levels, systemic activation of the immune system and reproductive success in infertile women, utilizing 2 distinct infertile patient cohorts. The mother’s immune system has to “reprogram” itself from rejection to tolerance. How this happens is only incompletely understood [1], but evidence suggests that a normal immune system does. Since even healthy individuals frequently, demonstrate laboratory evidence suggestive of immune system hyperactivity, normal quiescence versus activation is not well defined. Somewhat counter intuitively, we discovered that they demonstrated no evidence whatsoever of immune system activation as we initially had hypothesized; yet, young, healthy control patients with normal androgen levels, to some degree did demonstrate evidence of immune system activation [11]
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