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Domniz N, Meirow D. Premature ovarian insufficiency and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2019; 60:42-55. [PMID: 31495598 DOI: 10.1016/j.bpobgyn.2019.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/13/2023]
Abstract
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years and has a potentially devastating effect upon women's health, both physically and psychologically. An underlying autoimmune disease has been identified in approximately 20% of patients with POI, the most common of which are disorders of the thyroid and adrenal glands. Nevertheless, in the majority of cases, the etiology is unknown. The damage mechanism to the ovary is usually caused by antibodies, and autoimmune POI is usually characterized by cellular infiltration of the theca cells of growing follicles by various inflammatory cells. Yet, other various factors and proteins of unknown clinical significance are present. The major diagnostic tool for otherwise idiopathic POI is the presence of autoantibodies against various ovarian components that strongly support the option of autoimmune etiology of POI. Treatment of the underlying cause of POI is the main strategy, although immunosuppressive therapy should be considered in a selected population of well-defined autoimmune POI and, as in idiopathic POI, in whom the resumption of ovarian activity is possible.
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Affiliation(s)
- Noam Domniz
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel.
| | - Dror Meirow
- Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel
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Ovulation Induction is a More Effective Stimulant on Antiovarian Antibody Production than In Vitro Fertilization. Adv Ther 2016; 33:1408-16. [PMID: 27329382 DOI: 10.1007/s12325-016-0356-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Our aim in this study is to evaluate the effects of in vitro fertilization (IVF), including controlled ovarian hyperstimulation (COH) and the number of oocyte pick-up (OPU) procedures on the development of anti-ovarian antibodies (AOA). METHODS To evaluate the effects of IVF procedures, namely, COH and OPU, serum samples for measuring AOA concentration levels by enzyme-linked immunosorbent assay were collected on the third day of the menstrual cycle, at the end of the COH, and after OPU. RESULTS The AOA levels in IVF patients were significantly higher than the fertile control groups'. In the IVF group, neither COH nor OPU caused any increase in AOA levels when compared to the basal results. AOA levels were higher in patients with a history of 5-8 cycles of ovulation induction, before IVF treatment. There was no relationship between the basal AOA concentrations and the type of infertility, the etiology of infertility or the pregnancy outcomes, whereas there was a relationship between the AOA and the duration of infertility. CONCLUSION AOA levels of IVF patients were found to be higher than the fertile control groups'. AOA was found to be related to infertility in patients who had a longer duration of infertility and repeated ovulation induction procedures without IVF. COH and OPU during an IVF cycle did not cause an increase in AOA levels.
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Kadam KM, Mande PV, Gawas N, Ahire S, Khole LVV. Autoantibodies to Heat-Shock Protein, HSPA5, and Epitope Spreading: High-Dose Dexamethasone Therapy Rescues Ovarian Function in Experimental Autoimmune Ovarian Insufficiency Mouse Model. Am J Reprod Immunol 2016; 75:580-93. [PMID: 26840828 DOI: 10.1111/aji.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Role of autoantibodies to heat-shock protein 70 isoform, HSPA5, both alone or in combination with other antigenic peptides in epitope spreading and effect of high-dose dexamethasone to overcome this. METHOD OF STUDY Experimental autoimmune premature ovarian insufficiency mouse model generated by immunization with immunodominant epitopes of HSPA5 alone or in combination with other antigenic peptides. Two doses of dexamethasone treatment are given to the latter group. Immunosorbent assay and Western blot analysis were undertaken to detect cross-reactivity. Hormonal estimations, histological evaluation, and fertility studies were performed to assess treatment efficacy. RESULTS One of the immunodominant epitopes of HSPA5 led to epitope spreading. Of the two doses, 100 mg was more effective in rescuing fertility. CONCLUSIONS We postulate that the shared immunodominant peptide could be included in a peptide array to detect both HSAP5 and HSP90β autoantibodies for early diagnosis or prognosis of aPOI and customized glucocorticoid therapy for such subjects.
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Affiliation(s)
- Kaushiki M Kadam
- Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Mumbai, India
| | - Purvi V Mande
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nilesh Gawas
- Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Mumbai, India
| | - Sarika Ahire
- Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Mumbai, India
| | - Late Vrinda V Khole
- Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Mumbai, India
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Warren BD, Kinsey WK, McGinnis LK, Christenson LK, Jasti S, Stevens AM, Petroff BK, Petroff MG. Ovarian autoimmune disease: clinical concepts and animal models. Cell Mol Immunol 2014; 11:510-21. [PMID: 25327908 PMCID: PMC4220844 DOI: 10.1038/cmi.2014.97] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 01/08/2023] Open
Abstract
The ovary is not an immunologically privileged organ, but a breakdown in tolerogenic mechanisms for ovary-specific antigens has disastrous consequences on fertility in women, and this is replicated in murine models of autoimmune disease. Isolated ovarian autoimmune disease is rare in women, likely due to the severity of the disease and the inability to transmit genetic information conferring the ovarian disease across generations. Nonetheless, autoimmune oophoritis is often observed in association with other autoimmune diseases, particularly autoimmune adrenal disease, and takes a toll on both society and individual health. Studies in mice have revealed at least two mechanisms that protect the ovary from autoimmune attack. These mechanisms include control of autoreactive T cells by thymus-derived regulatory T cells, as well as a role for the autoimmune regulator (AIRE), a transcriptional regulator that induces expression of tissue-restricted antigens in medullary thymic epithelial cells during development of T cells. Although the latter mechanism is incompletely defined, it is well established that failure of either results in autoimmune-mediated targeting and depletion of ovarian follicles. In this review, we will address the clinical features and consequences of autoimmune-mediated ovarian infertility in women, as well as the possible mechanisms of disease as revealed by animal models.
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Affiliation(s)
- Bryce D Warren
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - William K Kinsey
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lynda K McGinnis
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lane K Christenson
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susmita Jasti
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anne M Stevens
- Research Center for Immunity and Immunotherapies, Children's Hospital and Regional Medical Center, and Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Brian K Petroff
- 1] Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA [2] Present address: Department of Pathobiology and Diagnostic Investigation, Michigan State University College of Veterinary Medicine, East Lansing, MI, USA
| | - Margaret G Petroff
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
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Caroppo E, D'Amato G. Resumption of ovarian function after 4 years of estro-progestin treatment in a young woman with Crohn's disease and premature ovarian insufficiency: a case report. J Assist Reprod Genet 2012; 29:973-7. [PMID: 22688827 DOI: 10.1007/s10815-012-9816-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/28/2012] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report the long-term management of a case of premature ovarian insufficiency of unknown origin in a young woman with Crohn's disease. METHOD Here is reported the case of a 20 years old woman with Crohn's disease presenting with two years amenorrhea and FSH and LH levels of 255 mIU/ml and 182 mIU/ml respectively, who received 10 months corticosteroid treatment followed by 7 years of estro-progestin treatment. RESULTS Corticosteroid treatment was ineffective in restoring patients gonadotropin levels as well as ovarian volume, while estro-progestins promoted a prompt reduction in gonadotrophin levels, which returned in the normal range after two years of treatment, as well as restoration of ovarian function, which occurred after four years of estrogens administration, as demonstrated by normal ovarian volume and ovulatory follicles at ultrasound, and by the re-establishment of regular menses after estroprogestin discontinuation. CONCLUSIONS Long-term suppression of the endogenous gonadotropins using estroprogestins may be suggested as a treatment able to restore ovarian responsiveness even in patients with premature ovarian insufficiency showing highly elevated gonadotropin levels.
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Affiliation(s)
- Ettore Caroppo
- ASL Bari, IVF Unit, P.O. Conversano, Via Edmondo De Amicis 5, Conversano, Ba, Italy.
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Can anti-ovarian antibody testing be useful in an IVF-ET clinic? J Assist Reprod Genet 2010; 28:55-64. [PMID: 20938805 DOI: 10.1007/s10815-010-9488-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/20/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To establish importance of anti-ovarian antibodies (AOA) testing in infertile women. DESIGN A clinical reproductive outcome comparative study between two groups of women undergoing IVF-ET. Group 1 consists of women tested positive for AOA, put on corticosteroid therapy, reverted to AOA negative and then taken up for IVF-ET. Group 2 were seronegative for AOA. SETTING Major urban infertility reference centre and National research institute. PATIENT(S) Five hundred seventy infertile women enrolled for IVF-ET. INTERVENTION(S) AOA testing, corticosteroid therapy and IVF-ET/ICSI. MAIN OUTCOME MEASURE(S) Comparable clinical outcome and significance of AOA testing established. RESULTS AOA positive serum samples were sent periodically to re-investigate presence of AOA after corticosteroid therapy and women turned AOA negative were taken up for IVF-ET. Of the 70/138 women in group 1 who were treated with corticosteroids and turned seronegative for AOA, 22/70 were poor responders and needed donor oocyte-recipient cycles. Results demonstrated that fertilization and clinical pregnancy rates between both groups are comparable. Nevertheless, it is also observed that there is poor response to stimulation protocol, smaller number of oocytes retrieved and more spontaneous abortions in group 1 women. Hence not all outcomes following the treatment are comparable between the two groups. Usefulness of the test was established in two case studies. CONCLUSIONS AOA testing could be included in the battery of tests investigating and treating infertility.
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An immunological insight into premature ovarian failure (POF). Autoimmun Rev 2010; 9:771-4. [PMID: 20601203 DOI: 10.1016/j.autrev.2010.06.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 06/23/2010] [Indexed: 01/22/2023]
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Edassery SL, Shatavi SV, Kunkel JP, Hauer C, Brucker C, Penumatsa K, Yu Y, Dias JA, Luborsky JL. Autoantigens in ovarian autoimmunity associated with unexplained infertility and premature ovarian failure. Fertil Steril 2010; 94:2636-41. [PMID: 20522323 DOI: 10.1016/j.fertnstert.2010.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify ovarian autoantigens associated with ovarian autoantibodies. DESIGN Hypothesis-generating prospective study. SETTING Urban infertility referral centers and academic research institution. PATIENT(S) Seventy-four patients with infertility, 19 patients with premature ovarian failure (POF), and 16 healthy control women. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Identification of autoantigens. RESULT(S) To identify major antigens for ovarian autoimmunity, sera from 74 women with unexplained infertility were screened for ovarian autoantibodies (AOAs) by immunoassay and one-dimensional Western blot. The majority of sera had immunoreactions at 50-56 kDa. Six representative positive infertility sera were used to identify antigens between 40 and 60 kD by two-dimensional Western blot and mass spectrometry. Antigens included aldehyde (retinal) dehydrogenases (ALDH1A1, ALDH1A2, and ALDH7A1), protein disulfide isomerase A3, vimentin, α-enolase, phosphoglycerate dehydrogenase, and selenium-binding protein 1 (SBP1). Sixty percent (24 out of 40) of infertility and POF sera were positive for recombinant ALDH1A1, SBP1, or enolase; 80.7% (21 out of 26) of AOA-positive sera had antibodies to one or more of the three antigens, and only 7% (1 out of 14) of AOA-negative sera had antibodies to recombinant proteins. CONCLUSION(S) ALDH1A1 and SBP1 are unique to ovarian autoimmunity associated with infertility and POF, and may provide the basis for specific tests to identify patients with ovarian autoimmunity.
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Affiliation(s)
- Seby L Edassery
- Department of Pharmacology, Rush University Medical Center, Chicago, Illinois 60612, USA
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BATS A, BARBARINO P, BENE M, FAURE G, FORGES T. Local lymphocytic and epithelial activation in a case of autoimmune oophoritis. Fertil Steril 2008; 90:849.e5-8. [DOI: 10.1016/j.fertnstert.2007.08.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 08/16/2007] [Accepted: 08/16/2007] [Indexed: 11/30/2022]
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Forges T, Monnier-Barbarino P, Guillet-May F, Faure GC, Béné MC. Corticosteroids in patients with antiovarian antibodies undergoing in vitro fertilization: a prospective pilot study. Eur J Clin Pharmacol 2006; 62:699-705. [PMID: 16847663 DOI: 10.1007/s00228-006-0169-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Antiovarian autoantibodies (AOA) have been associated with reproductive failure, especially in in vitro fertilization (IVF) patients. Thus, the success rate of IVF might be improved by the use of corticosteroids. However, therapeutic trials with these drugs have yielded conflicting results, particularly because of heterogeneous inclusion criteria. Among women with previous IVF failure, we selected those who presented with a positive serum AOA assay, and analysed the efficacy of corticosteroids in improving the IVF outcome in these patients. METHODS One hundred patients with serum AOA detected by ELISA and at least two previously failed IVF attempts were selected. These patients underwent a further IVF cycle with 0.5 mg/kg prednisolone, started on the first day of the treatment cycle. In patients who became pregnant, corticosteroids were administered until the end of the first trimester of pregnancy and then progressively discontinued. AOA were assessed before and after oocyte retrieval. Clinical data of the corticosteroid-treated cycle were compared with data from the preceding IVF cycle for each patient. RESULTS No adverse effects resulting from corticosteroids were observed. Post oocyte retrieval antiovarian IgG were significantly lower in corticosteroid-treated attempts when compared with the preceding cycles. Twenty-six pregnancies resulted in the birth of 30 healthy children. The pregnancy rate, implantation rate, and live birth rate were 38.8%, 17.8%, and 26.5% respectively in prednisolone-treated cycles. CONCLUSION This study confirms the usefulness of corticosteroids in improving the success rate in a subset of patients with previous IVF failure and significant serum AOA levels.
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Affiliation(s)
- Thierry Forges
- Department of Reproductive Medicine, Maternité Régionale Universitaire, 10, rue Dr Heydenreich CS74213, 54042 Nancy, France.
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Monnier-Barbarino P, Jouan C, Dubois M, Gobert B, Faure G, Béné MC. Anticorps anti-ovaires et fécondation in vitro : cause ou conséquence ? ACTA ACUST UNITED AC 2003; 31:770-3. [PMID: 14499725 DOI: 10.1016/s1297-9589(03)00209-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess anti-ovarian antibodies (AOA) in serum samples at various times of in vitro fertilization (IVF) attempts to determine whether ovarian stimulation could result in the production of such autoantibodies in women. PATIENTS AND METHODS Prospective study on 134 patients and 138 IVF cycles using a classical long protocol. For each attempt, four serum samples were obtained, respectively, at the onset of downrelation (S1), end of downregulation (S13), after 7 days of follicular stimulation (S21) and the day of follicular puncture (SP). Five hundred and fifty two samples were tested with an enzyme-linked immunosorbent assay for three isotypes (IgG, IgA, IgM) of AOA. RESULTS In the whole group, mean concentrations of AOA for each isotype were compared group by group: S1-S13, S1-S21, S1-SP, S13-S21, S13-SP, S21-SP. Not any significant difference was observed whatever the isotype considered. DISCUSSION AND CONCLUSION This study shows the absence of influence of endogenous or exogenous ovarian stimulation by gonadotropins on anti-ovarian autoimmunity.
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Affiliation(s)
- P Monnier-Barbarino
- UF de médecine de la reproduction et gynécologie médicale, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54042 Nancy cedex, France.
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Luborsky J. Ovarian autoimmune disease and ovarian autoantibodies. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:585-99. [PMID: 12396892 DOI: 10.1089/152460902760360540] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Detection of specific autoantibodies remains the most practical clinical and research marker of autoimmune disease. The lack of consensus on ovary specific antibodies as a marker for ovarian autoimmunity has clinical and research consequences. The objective of this review is to summarize the evidence for ovarian autoimmunity and the detection of ovary specific autoantibodies in humans. Evidence favors the presence of an autoimmune disease of the ovary. Ovarian autoantibodies are associated primarily with premature ovarian failure (POF) and unexplained infertility. Variations in detection of ovarian autoantibodies are likely to be due to study design elements such as antibody test format, antigen preparation, and criteria for study and comparison groups. In addition, multiple targets appear to be involved in ovarian autoimmunity including ovarian cellular elements and oocyte related antigens. Many studies only assess one target antigen, leaving individuals with ovarian autoimmunity unidentified. The next most significant advance in characterizing ovarian autoimmunity will be definitive identification of the specific antigens and development of standardized tests based on use of specific antigens.
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Affiliation(s)
- Judith Luborsky
- Reproductive Immunology, Department of Obstetrics and Gynecology, Rush Medical College, 1653 W. Congress Parkway, Chicago, IL 60612, USA
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Gobert B, Jolivet-Reynaud C, Dalbon P, Barbarino-Monnier P, Faure GC, Jolivet M, Béné MC. An immunoreactive peptide of the FSH involved in autoimmune infertility. Biochem Biophys Res Commun 2001; 289:819-24. [PMID: 11735119 DOI: 10.1006/bbrc.2001.6059] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to identify autoantigens contained in human ovary extracts. Serum samples from 36 infertile women with anti-ovary antibodies as detected with an ELISA technique were tested in Western blot against human ovary extracts. A reactive protein with a molecular mass matching that of the FSH was detected in 34 cases. These serum samples also reacted strongly in Western blot and ELISA with purified FSH and, in immunofluorescence, with pituitary cells. Using the Pepscan approach, with overlapping peptides matching the amino acid sequence of the human FSH beta-chain, several immunoreactive regions were evidenced. The 78-93 amino acid sequence of the human FSH beta-chain appeared as one of the major epitopes. Synthetic peptides of this region were prepared and demonstrated to react with human serum samples from women with anti-ovary antibodies. These data demonstrate that FSH can be an autoantigen, recognized by autoantibodies associated with infertility.
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Affiliation(s)
- B Gobert
- Laboratoire d'Immunologie, Faculté de Médecine, UHP Nancy I, Nancy, France
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Laml T, Schulz-Lobmeyr I, Obruca A, Huber JC, Hartmann BW. Premature ovarian failure: etiology and prospects. Gynecol Endocrinol 2000; 14:292-302. [PMID: 11075301 DOI: 10.3109/09513590009167696] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A search of past and current articles on ovarian physiology and premature ovarian failure (POF) using MEDLINE was performed in order to present an overview of clinical manifestations, necessary laboratory investigations, possible etiologies and treatments for POF. POF is defined as gonadal failure before the age of 40 years. Initially, POF was thought to be permanent, but it is now believed that spontaneous remissions and even pregnancies are possible in affected women. In most cases, the etiology of POF remains elusive, but several rare specific causes have been identified. Although the etiology of POF is heterogenic, the treatment principles are the same. Hormone replacement therapy (HRT) is still the cornerstone of treatment. The only proven method of obtaining a pregnancy in patients with POF is fertilization of a donor oocyte. Cryopreservation of oocytes has worked well in animals but awaits refinement before it can be applied routinely to humans with prodromal POF, or to patients before chemotherapy or irradiation in order to save their oocytes for future fertilization. New alternatives to traditional HRT and methods of fertility preservation are under development, but understanding of the basic pathophysiology of POF is necessary for the development and use of innovative treatments.
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Affiliation(s)
- T Laml
- Division of Gynecology, University of Vienna Medical School, Austria
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Geva E, Fait G, Lerner-Geva L, Lessing JB, Swartz T, Wolman I, Daniel Y, Amit A. The possible role of antiovary antibodies in repeated in vitro fertilization failures. Am J Reprod Immunol 1999; 42:292-6. [PMID: 10584984 DOI: 10.1111/j.1600-0897.1999.tb00104.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM The study was conducted to investigate the possible role of circulating ovarian autoantibodies (ov-ab) in patients with repeated in vitro fertilization embryo transfer (IVF-ET) failure and to evaluate the effectiveness of immunosuppression treatment in these patients. METHOD OF STUDY The study group comprised 80 IVF patients who had five or more failed treatment cycles (mean 10.2; range 7-22). The presence of ov-ab was compared between these women and 1) 50 IVF patients who conceived during the first three treatment cycles; 2) 50 healthy nulligravidae. All participants were seronegative to nonorgan-specific and antithyroid autoantibodies. Patients in the study group who were positive for ov-ab were treated with 10 mg/day prednisone starting 1 month before ovulation induction. Embryo grading was compared in the IVF cycles before and after treatment. RESULTS Ov-ab were found in ten patients (12.5%) in the study group, compared to none in the control groups (P = 0.01). Nine of the patients positive for ov-ab were treated with prednisone for their following cycle. A statistically significant improvement in embryo grading was noted. Three patients conceived after treatment (33%), with a take-home baby rate of 22%, compared to only six patients (8.6%) who conceived among the rest of the seronegative study group, with a take-home baby rate of 7.1% (P = 0.05). CONCLUSIONS Ov-ab are a possible marker of an autoimmune disorder that may be one of the causes of repeated IVF failures. Immunosuppression treatment may prove efficient in ov-ab seropositive patients with repeated IVF failures by improving embryo grading and pregnancy rate.
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Affiliation(s)
- E Geva
- Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel
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