Immunology Testing and Fertility: A Modern Approach for Complex Cases

For couples facing fertility challenges, the journey to parenthood can be long and emotionally taxing. Traditional IVF isn’t always successful, particularly for those with complex underlying conditions like polycystic ovary syndrome (PCOS) and endometriosis. Emerging research suggests that addressing immune system imbalances may offer a new path to pregnancy for these individuals.

The Complexities of PCOS and Endometriosis

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age, often characterized by irregular periods, excess androgen, and cysts on the ovaries. Endometriosis, affecting an estimated 10% of women, involves tissue similar to the uterine lining growing outside the uterus, causing inflammation and potential fertility issues. Both conditions can independently, or in combination, create significant obstacles to conception.

The Role of the Immune System in Fertility

The human immune system is designed to protect the body from foreign invaders. However, when it comes to pregnancy, a delicate balance is required. An embryo, containing genetic material from both parents, is partially “foreign” to the mother’s immune system. A healthy immune system recognizes the embryo as semi-foreign and releases protective antibodies to prevent rejection and maintain the pregnancy.

However, in some women, particularly those with autoimmune conditions or inflammatory disorders like endometriosis, the immune system may be overactive and attack the embryo. This can lead to implantation failure or early miscarriage.

Immunological Testing: Identifying Imbalances

Traditional fertility testing often focuses on hormonal levels and the physical structure of the reproductive organs. Immunological testing takes a different approach, examining the levels of natural killer (NK) cells and cytokines – proteins that signal immune responses – in the blood and uterus.

The Chicago blood test, costing up to €1,100, assesses NK cell levels and cytokine profiles. A uterine biopsy can also be performed to evaluate NK cell activity within the uterus itself. These tests aim to determine whether the immune system is pro-inflammatory (potentially rejecting the embryo) or anti-inflammatory (supporting the pregnancy).

Personalized Treatment Approaches

Based on the results of immunological testing, clinicians can develop personalized treatment plans to modulate the immune system. These may include:

• Immune-modulating medications: Such as steroids, to reduce inflammation and suppress the immune response.
• Intralipid infusions: To facilitate regulate immune function.
• Low-dose aspirin: To improve blood flow to the uterus and reduce inflammation.

A Patient’s Story

Caitríona O’Donnell, a 34-year-old occupational therapist from Limerick, Ireland, experienced years of unsuccessful IVF cycles due to PCOS and stage-four endometriosis. After immunological testing revealed high levels of NK cells and cytokines, she received a personalized treatment protocol from Dr. Lyuda Shkrobot at UNQLife Clinic in Dublin. Following this treatment, O’Donnell successfully carried a pregnancy to term, giving birth to her daughter in October 2025.

The Future of Fertility Treatment

While the science behind immunological testing and treatment is still evolving, it offers a promising avenue for couples who have experienced recurrent IVF failures or unexplained infertility. Experts urge anyone with a history of recurrent miscarriage, particularly those with inflammatory conditions, to discuss immunological testing with their fertility specialist.

According to the HSE, one in six couples in Ireland experiences fertility issues, and 20% to 30% of those will be diagnosed with unexplained infertility. Immunological approaches may provide answers and solutions for some of these challenging cases.