akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2024.532akusherstvo-2117Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫImmunological testing for female infertility: a modern view on the problemИммунологическое тестирование при женском бесплодии: современный взгляд на проблемуhttps://orcid.org/0009-0000-3357-5095КонкинаА. В.KonkinaA. V.

Конкина Анастасия Владимировна.

355017 Ставрополь, ул. Мира, д. 310

Anastasia V. Konkina.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0000-6529-2444БликянЛ. А.BlikyanL. A.

Бликян Лилит Ашотовна.

355017 Ставрополь, ул. Мира, д. 310

Lilit A. Blikyan.

310 Mira Str., Stavropol 355017

lilit.blikyan@mail.ruhttps://orcid.org/0009-0005-8656-2139АлейниковаД. Э.AleynikovaD. E.

Алейникова Дарья Эдуардовна.

356800 Буденновск, проспект Калинина, д. 2

Daria E. Aleynikova - MD.

2 Kalinin Avenue, Budyonnovsk 356800

https://orcid.org/0009-0008-8759-5196АбубакаровИ. Р.AbubakarovI. R.

Абубакаров Изнаур Русланович.

355017 Ставрополь, ул. Мира, д. 310

Ilzanur R. Abubakarov.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0008-8759-5196ДжуманьязоваА. С.DzhumanyazovaA. S.-M.

Джуманьязова Аида Султан-Муратовна.

355017 Ставрополь, ул. Мира, д. 310

Aida S.-M. Dzhumanyazova.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0009-2804-1932АбрамьянА. В.AbramianA. V.

Абрамьян Александра Вячеславовна.

355017 Ставрополь, ул. Мира, д. 310

Alexandra V. Abramian.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0009-2983-5523ГафуроваЛ. Г.GafurovaL. G.

Гафурова Лиана Гамидовна.

355017 Ставрополь, ул. Мира, д. 310

Liana G. Gafurova.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0002-7748-435XЛобкоД. А.LobkoD. A.

Лобко Дарья Артемовна.

355017 Ставрополь, ул. Мира, д. 310

Daria A. Lobko.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0005-0824-0433ПозоянА. А.PozoyanA. A.

Позоян Анна Айрапетовна.

355017 Ставрополь, ул. Мира, д. 310

Anna A. Pozoyan.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0003-6119-0004ТхагапсоваК. М.ThagapsovaK. M.

Тхагапсова Камила Муратовна.

355017 Ставрополь, ул. Мира, д. 310

Kamila M. Thagapsova.

310 Mira Str., Stavropol 355017

https://orcid.org/0009-0004-1982-7603ГолубеваМ. С.GolubevaM. S.

Голубева Майя Сергеевна.

197022 Санкт-Петербург, ул. Льва Толстого, д. 6–8

Maya S. Golubeva.

197022 Saint Petersburg, Lev Tolstoy Str., 6–8

https://orcid.org/0009-0003-8544-7863ШвановаЕ. Е.ShvanovaE. E.

Шванова Евгения Евгеньевна.

390026 Рязань, ул. Высоковольтная, д. 9

Evgeniya E. Shvanova.

390026 Ryazan, Vysokovoltnaya, 9

https://orcid.org/0009-0002-4293-7507РыжовЕ. О.RyzhovE. O.

Рыжов Евгений Олегович.

295051 Симферополь, бульвар Ленина, д. 5/7

Evgeniy O. Ryzhov.

5/7 Lenin Boulevard, Simferopol 295051

ФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияStavropol State Medical University, Health Ministry of Russian FederationRussian FederationГБУЗ Ставропольского края «Краевой центр специализированных видов медицинской помощи № 1»РоссияStavropol Regional Center of Specialized Types of Medical Care No. 1Russian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov First Saint Petersburg State Medical University, Health Ministry of Russian FederationRussian FederationФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov Ryazan State Medical University, Health Ministry of Russian FederationRussian FederationФГАОУ ВО «Крымский федеральный университет имени В.И. Вернадского»РоссияVernadsky Crimean Federal UniversityRussian Federation202425072024184547562Copyright © Konkina A.V., Blikyan L.A., Aleynikova D.E., Abubakarov I.R., Dzhumanyazova A.S., Abramian A.V., Gafurova L.G., Lobko D.A., Pozoyan A.A., Thagapsova K.M., Golubeva M.S., Shvanova E.E., Ryzhov E.O., 20242024Конкина А.В., Бликян Л.А., Алейникова Д.Э., Абубакаров И.Р., Джуманьязова А.С., Абрамьян А.В., Гафурова Л.Г., Лобко Д.А., Позоян А.А., Тхагапсова К.М., Голубева М.С., Шванова Е.Е., Рыжов Е.О.Konkina A.V., Blikyan L.A., Aleynikova D.E., Abubakarov I.R., Dzhumanyazova A.S., Abramian A.V., Gafurova L.G., Lobko D.A., Pozoyan A.A., Thagapsova K.M., Golubeva M.S., Shvanova E.E., Ryzhov E.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2117Introduction

Introduction. According to various estimates, in Russia 10 to 20 % of people of reproductive age are infertile. Changes in the immune system play a key role in the etiology and treatment of various infertility forms. The active introduction of immunological testing into clinical practice can potentially improve the results of infertility diagnostics and treatment.

Aim

Aim: to analyze the current literature data on immunological testing in female infertility, as well as to assess its potential role in infertility diagnostics and treatment.

Materials and Methods

Materials and Methods. There was conducted a search for publications in the electronic databases PubMed and eLibrary by using the following keywords and their combinations: "infertility", "immunology", "immune system", "immunological testing", "diagnostics", "treatment". The articles were evaluated in accordance with the PRISMA recommendations. Ultimately, 88 publications were included in the review.

Results

Results. Testing for antiphospholipid antibodies (APA) may be useful for women undergoing assisted reproductive technology (ART) therapy, as these antibodies increase the risk of pregnancy complications and thrombotic risks associated with ovarian stimulation, but studies assessing AFA effect on in vitro fertilization (IVF) outcomes have ambiguous results. The presence of antithyroid antibodies (ATA) may be associated with infertility, so their assessment is indeed important to determine treatment tactics. It has been suggested that antinuclear antibodies (ANA) may affect reproductive function by disrupting trophoblast cell development and interfering with RNA transcription, which may lead to lowered reproductive success. Studies have shown that patients with a positive ANA data have a lower incidence of pregnancy and a higher rate of miscarriages after IVF procedure. The human herpes virus type 6 (HHV-6) affects female fertility and is often the cause of spontaneous termination of pregnancy. B-cell lymphoma protein 6 (BCL-6) can serve as an important prognostic biomarker to identify individuals with endometriosis and related reproductive disorders, including idiopathic infertility. Evaluation of endometrial decidualization can be a useful tool to assess readiness for endometrial implantation and provide opportunities for targeted therapeutic interventions. The issue of testing for NK-cells in patients undergoing infertility screening remains controversial due to the difficulties of standardizing testing recommendations.

Conclusion

Conclusion. To date, there is a limited number of reliable data on the role of various immunological tests in infertility diagnostics and treatment. With the exception of testing for AFA in patients with RPL, as well as for thyroid-stimulating hormone (TSH) and anti-thyroperoxidase antibodies (TPOAb) in patients undergoing therapy using various types of assisted reproductive technologies, the remaining immunological tests provide scant data to justify their routine use in clinical practice. The major limitations of existing studies are coupled to a small patient sample, as well as heterogeneity of inclusion criteria, patient groups and research methods.

Введение

Введение. По разным оценкам, в России бесплодны от 10 до 20 % людей репродуктивного возраста. Изменения в иммунной системе играют ключевую роль в этиологии и лечении различных форм бесплодия. Активное внедрение иммунологического тестирования в клиническую практику потенциально может улучшить результаты диагностики и лечения бесплодия.

Цель

Цель: проанализировать современные литературные данные, посвященные иммунологическому тестированию при женском бесплодии, а также оценить его потенциальную роль в диагностике и лечении бесплодия.

Материалы и методы

Материалы и методы. Проведен поиск публикаций в электронных базах данных PubMed и еLibrary. Для поиска использовались следующие ключевые слова и их сочетания на русском и английском языке: «бесплодие», «иммунология», «иммунная система», «иммунологическое тестирование», «диагностика», «лечение», «infertility», «immunology», «immune system», «immunological testing», «diagnostics», «treatment». Статьи оценивали в соответствии с рекомендациями PRISMA. В конечном итоге в обзор было включено 88 публикаций.

Результаты

Результаты. Тестирование на антифосфолипидные антитела (АФА) может быть полезно для женщин, проходящих терапию с использованием вспомогательных репродуктивных технологий (ВРТ), так как эти антитела повышают риск осложнений беременности и тромботических рисков, связанных со стимуляцией яичников; однако исследования влияния АФА на исходы экстракорпорального оплодотворения (ЭКО) дают неоднозначные результаты. Наличие антитиреоидных антител (ATA) может быть связано с бесплодием, поэтому их оценка действительно важна для определения тактики лечения. Существует предположение, что антинуклеарные антитела (АНА) могут влиять на репродуктивную функцию, нарушая развитие клеток трофобласта и препятствуя транскрипции РНК, что может привести к снижению репродуктивного успеха. Исследования показали, что у пациенток с положительным результатом на АНА наблюдается более низкая частота наступления беременности и более высокий уровень выкидышей после процедуры ЭКО. Вирус герпеса человека 6-го типа (ВГЧ-6) оказывает влияние на фертильность женщин и нередко является причиной самопроизвольного прерывания беременности. Белок 6 В-клеточной лимфомы (англ. B-cell lymphoma protein 6, BCL-6) может служить важным прогностическим биомаркером для выявления лиц с эндометриозом и связанными с ним нарушениями репродуктивной функции. Оценка децидуализации эндометрия может стать полезным инструментом для определения готовности к имплантации эндометрия и предоставления возможностей для проведения целенаправленных терапевтических вмешательств. Вопрос тестирования на NK-клетки у пациентов, проходящих обследование по поводу бесплодия, остаётся дискуссионным из-за сложностей стандартизации рекомендаций по тестированию.

Заключение

Заключение. На сегодняшний день имеется ограниченное количество достоверных данных, посвященных роли различных иммунологических тестов в диагностике и лечении бесплодия. За исключением тестирования на АФА у пациенток с привычным невынашиванием беременности, а также на тиреотропный гормон (ТТГ) и антитела к тиреопероксидазе (TPOAb) у пациенток, проходящих терапию с использованием различных видов ВРТ, остальные иммунологические тесты имеют скудные данные для обоснования их рутинного использования в клинической практике. Основными ограничениями существующих исследований являются небольшая выборка, а также неоднородность критериев включения, групп пациентов и методов исследования.

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The authors declare that there are no conflicts of interest present.