Immune Infertility

This book offers comprehensive coverage of both basic and clinical aspects of immune reactions responsible for infertility. It has four sections focusing on Sperm antigens, Antisperm antibodies (ASAs), Clinical impact of ASAs, and Immune contraception, and include contributions from leading experts in these fields. This new edition of the book offers a comprehensive update that reflects the very significant advances in reproductive immunology that have been achieved over the past five years, especially related to the sperm proteome, sperm-egg binding/fusion proteins, gene knockout studies, and immunocontraception. Reproductive immunology continues to be a fast-growing discipline in which new knowledge is emerging almost every day. Immune Infertility is a model source of vital and reliable information on the latest scientific developments in the field. It will be of value for clinicians, scientists, students, residents, and fellows working in reproductive biology, obstetrics and gynecology, and urology.

Infertility is defned as the inability to conceive after having unprotected intercourse for a year. Infertility is increasing worldwide and has various causes both in the male and the female partner. Immune reactions to sperm can contribute up to 2–30% of infertility. The sperm has both autoantigenic as well as isoantigenic potential, and is thus capable of p- ducing antisperm antibodies (ASAs) and sperm-reactive T cells in both infertile men and women. Also, over 75% vasectomized men produce autoantibodies to sperm that can cause a problem in regaining fertility even after successful re-anastomosis in vasovasostomy. Early claims regarding the incidence and involvement of ASAs in involuntary human infertility were probably overemphasized because of unreliable techniques and naivety concerning the complexity of the immune response and antigenic nature of the sperm cell. These factors, the lack of well-designed and controlled experimental studies, and the dearth of effective therapeutic modalities resulted in the confusion of the occurrence and importance of ASAs in human infertility. Consequently, evaluation of infertile couples for ASAs and their possible role in infertility was not considered a signifcant proposition. The development of more accurate assays and the discovery of mucosal immunity capable of responses independent of systemic immunity have caused inclusion of sperm cells and genital tract secretions in the analysis of ASAs.

Infertility is defned as the inability to conceive after having unprotected intercourse for a year. Infertility is increasing worldwide and has various causes both in the male and the female partner. Immune reactions to sperm can contribute up to 2–30% of infertility. The sperm has both autoantigenic as well as isoantigenic potential, and is thus capable of p- ducing antisperm antibodies (ASAs) and sperm-reactive T cells in both infertile men and women. Also, over 75% vasectomized men produce autoantibodies to sperm that can cause a problem in regaining fertility even after successful re-anastomosis in vasovasostomy. Early claims regarding the incidence and involvement of ASAs in involuntary human infertility were probably overemphasized because of unreliable techniques and naivety concerning the complexity of the immune response and antigenic nature of the sperm cell. These factors, the lack of well-designed and controlled experimental studies, and the dearth of effective therapeutic modalities resulted in the confusion of the occurrence and importance of ASAs in human infertility. Consequently, evaluation of infertile couples for ASAs and their possible role in infertility was not considered a signifcant proposition. The development of more accurate assays and the discovery of mucosal immunity capable of responses independent of systemic immunity have caused inclusion of sperm cells and genital tract secretions in the analysis of ASAs.

The second edition of this popular text systematically addresses all aspects of treatment of infertility using Chinese medicine. Clinically focused and with a new easy-to-navigate design, the book begins by covering all the essential fundamentals you will need to understand and treat infertility, before going on to look at what Chinese medicine offers in the way of treatment for functional infertility in men and women, gynecological disorders which contribute to infertility and relevant lifestyle factors. Jane Lyttleton importantly devotes a large part of the book to discussing ways in which Chinese medicine and Western medicine might work together to overcome infertility, and details the increased experience over the past decade in working with IVF patients and their specialists. Leaps forward have also been made in the understanding of conditions such as Polycystic ovarian syndrome and immune infertility. New Features · Greatly expanded section on the place of Chinese medicine and IVF in treatment of infertility · New information on Polycystic ovarian disease and immune infertility and how Chinese medicine approaches their treatment · Updated and balanced advice on pre-conception care · Clinically focused, with easy-to-navigate design

Now in its second edition, the Oxford Textbook of Endocrinology and Diabetes is a fully comprehensive, evidence-based, and highly-valued reference work combining basic science with clinical guidance, and providing first rate advice on diagnosis and treatment.

Contraceptive research has entered the new age of vaccines. Realistic prospects exist for the development of an entirely new battery of vaccines for use in human and veterinary medicine. Among them may be anti-fertility vaccines, based on physiological mechanisms applicable to either the female or male. This volume is a comprehensive review - a status report - of the subjects including fundamental work on the search for useful epitopes and ranging to applied vaccinology. One vaccine to prevent pregnancy, for use by women, has already been studied extensively. G.P. Talwar, the volume's editor and his colleagues in New Oelhi, India, published in 1976 a landmark series of papers describing the immunological properties of a preparation consisting of the alum-precipitated beta-subunit of human chorionic gonadotropin (hCG) chemically linked to tetanus toxoid. The principle of enhancing antigenicity of a self-protein by linkage of the epitope to a carrier protein was employed and tested clinically. These trials, carried out under the auspices of the Indian Council for Medical Research, were the first application of the carrier protein concept for a vaccine for human use. The encouraging results stimulated a wave of research not only on the use of hCG-based vaccines, but on other antigens as well.

This revised edition of the landmark text includes the latest tests and treatments for those who are experiencing unexplained IVF failure, recurrent miscarriage, or long term infertility. An over activated immune response to pregnancy and blood clotting problems are now being identified in women with these previously "unexplained" conditions. Over half of fertility centers now recommend immune evaluation for women with a history of loss or two or more IVF failures. Centers that specialize in reproductive immunology are seeing success rates of over 85% within three cycles and even saving some couples from expensive and often futile IVF treatment. A fully updated list of all these centers, in the US and abroad, is provided in this book, making this a vital resource for all couples considering fertility treatment and looking for the best options in their area.

Reproductive Immunology is a compilation of research articles presented during the VII International Congress of Reproductive Immunology which was held in New Delhi, India on 27-30 October 1998. The articles pertain to the following six major themes: Molecular and Immunological Aspects of Sperm-Egg Interaction Embryonic-Endometrial Cross-Talk Immunobiology of Pregnancy Autoantibodies and Infertility Immunocontraception Mucosal Immunology and Reproductive Tract Infections . The first section deals with our current understanding of various steps involved in fertilization. The functional significance of sperm surface mannosidase and glutathione S-transferases to bind zona pellucida is described. The role of zona pellucida glycoproteins in the binding of sperm, induction of acrosome reactions and avoidance of polyspermy is discussed. In the second section, the role of various cytokines, growth factors and immunomodulatory agents in implantation of embryos is described. In the field of reproductive immunology, one of the major issues is to explore the successful gestation of the histoincompatible fetus in the uterus of an immunologically competent mother. The Proceedings presents the issues of paternal antigens at the feto-maternal interface and shows that Th2-type of immunity is involved in normal successful conception. The role of membrane-bound and soluble HLA-G in protecting the fetus from the lytic activities of maternal uterine and peripheral blood natural killer (NK) cells is also presented. Nature's experiments suggest that antibodies against sperm-specific antigens are responsible for infertility in some women. The possibility that an immunogenetic background contributes to production of sperm-immobilizing antibodies in infertile women is discussed in the section on autoantibodies and infertility. The Proceedings presents the issue of Th1-type cytokines in inducing recurrent spontaneous abortions of unexplained etiology. The roles of β2-glycoprotein 1 (β2-GP1)-dependent anticardiolipin antibody, lupus anticoagulant, antiphospholipids, anti-thyroid antibody and anti-nuclear antibody in miscarriages are also described. The rising global human population, particularly in the developing countries, has driven the need for new and safer methods of contraception. Fertility regulation by vaccines is thus an interesting proposition. The section on contraceptive vaccines discusses the latest advances in this area and describes the current status of vaccines based on βhCG, sperm antigens, zona pellucida glycoproteins, and riboflavin carrier proteins. The issues of mucosal immunity and strategies for enhancing local genital immune responses to combat HIV infection is discussed. The role of inflammatory and related cytokines in chorioamnionitis is described. The contents of this Proceedings describes various facets of reproductive immunology which will help us to design strategies to combat genital infections and miscarriages caused by immunological etiology. Descriptions of the molecular basis of gamete recognition, implantation and survival of the allogenic fetus will help in designing strategies for overcoming infertility and also new contraceptive approaches. The Proceedings will be useful to researchers and clinicians involved in basic or applied research in the disciplines of reproductive biology, reproductive immunology, and obstetrics and gynecology.