IS SUBCLINICAL OVARIAN FAILURE AN AUTOIMMUNE-DISEASE

Young women with unexplained infertility who exhibit elevated basal se rum follicle stimulating hormone (FSH) concentrations (>10 IU/1) have poor outcomes in in-vitro fertilization. A subgroup of these women has regular menses, representing 'subclinical' ovarian failure, which may have an autoimmune basis and could potentially be treated by immunosu ppression. To investigate this further, a range of immunological marke rs was used to assess autoimmune activity in 14 women aged <40 years w ith elevated FSH compared with 15 infertile women with normal FSH and 10 pre-menopausal, healthy controls. All samples were taken during nat ural menstrual cycles. Organ-specific antibodies against ovary, endome trium and thyroid, and non-organ-specific antibodies against histones and cardiolipin, were not significantly increased in elevated FSH pati ents compared with other control groups. Soluble CD23 and soluble inte rcellular adhesion molecule concentrations were not elevated in the se ra of the women tested, and circulating T cell subsets remained unalte red. Significantly, increased concentrations of the complement breakdo wn product C3a and terminal complement complexes were detected in the elevated FSH group compared with the normal FSH group, although the la tter also had significant complement activation compared with laborato ry controls. Autoimmunity appears as an infrequent cause of 'subclinic al' ovarian failure, but there is evidence of activation of complement in the sera of infertile women.