PROBLEM:Autoimmune mechanisms are involved in etiology of female infertility, the medical problem frequently treated by in vitro fertilization (IVF). Controlled ovarian hyperstimulation (COH) with supraphysiological levels of sex hormones is achieved by IVF. METHODS OF STUDY:Anti-human-ovary and eight common autoantibodies [nuclear (ANA-H, ANA-R on human HEp-2 cell line and rodent antigen, respectively), smooth muscle (SMA), parietal cell, thyroid microsomal, mitochondrial, beta2-glycoprotein-I, cardiolipin antibodies] found in IVF patients (n = 129) were analyzed with regard to the number of previous IVF procedures and the age of the patient. The changes in autoimmune reactions caused by the COH were determined. RESULTS:Endometriosis and polycystic ovary syndrome were associated with a higher number of common serum autoantibodies compared with the tubal factor infertility (Proportion test, P < 0.05). ANA-R was associated with unexplained infertility [adjusted odds ratio (aOR) 8.79, P = 0.038]. SMA correlated with endometriosis (aOR 37.29, P = 0.008), male factor infertility (aOR 20.45, P = 0.018) and with the previous IVF procedures (aOR 2.87, P = 0.013). There was an overall decrease in the number of detectible autoantibodies after COH (Proportion test, P < 0.05). CONCLUSION:COH may have a suppressive effect on the humoral immunity by the time of embryo transfer but more conclusive studies are needed.

译文

问题:女性不孕症的病因涉及自身免疫机制,这是经常通过体外受精(IVF)解决的医学问题。 IVF可实现具有超生理水平的性激素的受控卵巢过度刺激(COH)。
研究方法:抗人卵巢和八种常见的自身抗体[核(分别针对人类HEp-2细胞系和啮齿动物抗原的ANA-H,ANA-R),平滑肌(SMA),壁细胞,甲状腺微粒体,线粒体对IVF患者(n = 129)中发现的[β2-糖蛋白I,心磷脂抗体]进行了分析,以了解先前的IVF手术次数和患者年龄。确定了由COH引起的自身免疫反应的变化。
结果:子宫内膜异位症和多囊卵巢综合症与输卵管因素不孕症相比,血清中常见的自身抗体数量更高(比例检验,P <0.05)。 ANA-R与原因不明的不孕症相关[校正比值比(aOR)8.79,P = 0.038]。 SMA与子宫内膜异位症(aOR 37.29,P = 0.008),男性不育症(aOR 20.45,P = 0.018)和以前的IVF程序(aOR 2.87,P = 0.013)相关。 COH后可检测到的自身抗体数量总体上减少了(比例测试,P <0.05)。
结论:COH可能在胚胎移植时对体液免疫有抑制作用,但还需要更多的结论性研究。

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