AUTOANTIBODY PROFILES AND IMMUNOGLOBULIN LEVELS AS PREDICTORS OF IN-VITRO FERTILIZATION SUCCESS

OBJECTIVE: Our aim was to determine the predictive value of autoantibo dy and immunoglobulin determinations as indicators of the success of i n vitro fertilization. STUDY DESIGN: This was a blinded study in which laboratory evaluations were performed on coded samples obtained from another institution. Codes were broken and data were analyzed after re sults of all laboratory tests had been reported out. One hundred five infertility patients who had undergone in vitro fertilization were ran domly chosen. Among those, 46 were considered low responders (six or f ewer oocytes were retrieved) and 59 as high responders (13 to 30 oocyt es were retrieved). Total immunoglobulin G, M, and A levels and 15 aut oantibody levels (6 antiphospholipids, 5 antihistones, and 4 antipolyn ucleotides) were determined separately for immunoglobulin G, immunoglo bulin M, and immunoglobulin A isotypes. RESULTS: High and low responde rs demonstrated an unusual incidence of autoantibody (25% and 30%, res pectively) and immunoglobulin (46% and 48%, respectively) abnormalitie s. They did not differ from each other, however, in either immunoglobu lin or autoantibody parameters. Autoantibody and immunoglobulin abnorm alities alone or in combination did not predict pregnancy success (24% vs 16%), incidence of chemical pregnancies (15% vs 24%), or clinical pregnancy loss (9% vs 11%) when such women were compared with those wi thout either abnormality. However, the occurrence of hypergammaglobuli nemias, in contrast to hypogammaglobulinemias, was associated with a s ignificant decrease in the clinical pregnancy rate (6% vs 24%, p = 0.0 5). CONCLUSIONS: Neither autoantibody abnormalities nor total immunogl obulin abnormalities allow differentiation between high and low respon ders in in vitro fertilization cycles. The presence of autoantibody an d total immunoglobulin abnormalities also does not predict low clinica l pregnancy rates. Within a group of women with immunoglobulin abnorma lities, those with hypergammaglobulinemias appear, however, at signifi cant risk for low pregnancy rates with in vitro fertilization. This ob servation suggests that high total immunoglobulin levels may serve as a marker for an as yet to be determined immunologic factor that advers ely affects the chance of conception. The evaluation of total immunogl obulin levels may be indicated as part of a routine infertility workup .