SHARING OF HUMAN-LEUKOCYTE ANTIGENS IN COUPLES WITH UNEXPLAINED INFERTILITY AFFECTS THE SUCCESS OF IN-VITRO FERTILIZATION AND TUBAL EMBRYO-TRANSFER

OBJECTIVE: The purpose was to test further our hypothesis that genes, or genetic defects, linked to the major histocompatibility complex aff ect reproduction by correlating human leukocyte antigen sharing with t he success or failure of in vitro fertilization and tubal embryo trans fer in couples having unexplained infertility. STUDY DESIGN: Seventy-s ix couples with unexplained infertility who failed superovulation and intrauterine insemination at least three times were typed for human le ukocyte antigens and treated by in vitro fertilization and tubal embry o transfer. The results were correlated with the sharing of human leuk ocyte antigens in the couples. RESULTS: Thirty-four of the women had s uccessful pregnancies, 36 did not become pregnant, and six became preg nant but aborted shortly thereafter. There was a highly significant ex cess of human leukocyte antigen sharing in the couples who failed trea tment: three of the A, B, DR, and DQ antigens (p = 0.015) or two of th e B, DR, and DQ antigens (p = 0.015). No specific human leukocyte anti gen alleles were present in excess. CONCLUSIONS: Genes, or genetic def ects, linked to the major histocompatibility complex significantly aff ect the success of in vitro fertilization and tubal embryo transfer ju st as they affect the prevalence of recurrent spontaneous abortion, ca ncer, and congenital anomalies. It appears as if the critical genes, o r genetic defects, are located in the B-DR-DQ region of the major hist ocompatibility complex.