Immunological factors in female infertility: Antithyroid and Antiphospholipid antibodies

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Mixed findings regarding the association between the presence of autoantibodies (TPO-abs, TG-abs and APL-abs) and female infertility besides spontaneous abortion have been reported in most studies in developed countries. To screen for these autoantibodies still remains divisive. Additionally, very little is known about their relationship with menstrual abnormalities, body mass index (BMI) and haematological parameters in infertile women in developing countries. The aim of this study was to investigate the relationship between a panel of autoantibodies (TPO-abs, TG-abs and APL-abs) and infertility, spontaneous abortion, menstrual abnormalities, body mass index and haematological parameters. A case-control study comprising 52 infertile cases and 38 fertile controls in three major hospitals in the Ashanti region of Ghana was undertaken. A standard questionnaire was administered, blood pressure (BP) measured and BMI computed from the weight and height. Blood specimen was collected for haematological (NLR, PLR, #NEUT and #Lymphocyte) and biochemical analysis (TPO-abs, TG-abs and APL-abs). TPO-abs (IgG) >100IU/mL and TG-abs (IgG) >100IU/mL were regarded as positives for the thyroid autoantibodies while APL-abs (IgG/IgM) ≥10U/mL was also regarded as positive for the antiphospholipid antibodies. Infertility was found to be significantly associated with the presence of thyroperoxidase antibody (TPO-abs: χ2 (1) = 7.047, p=0.011) and antiphospholipid antibody positivity (APL-abs: χ2 (1) = 5.55, p=0.02) but not thyroglobulin antibody positivity (χ2 (1) = 0.907, p=0.357). Neither of the three autoantibodies (TPO-abs, TG-abs and APL-abs) was found to be associated with a history of spontaneous abortion (p>0.05). The odds of APL and both (TPO+TG-abs) positivity were found to be 1.71 and 1.45 times greater respectively among infertile women with menstrual abnormalities compared to those without menstrual abnormalities [APL-abs: (OR=1.71, (95% CI): 0.18-15.95; p=0.636) ; TPO + TG-abs: (OR =1.45, (95% CI): 0.27-7.82; p=0.667)], however both associations were not significant. BMI was comparable between infertile cases and fertile controls and did not correlate significantly with any of the autoantibodies. Neutrophil-lymphocyte ratio (NLR), Platelet-lymphocyte ratio (PLR), absolute neutrophils (#NEUT) and absolute lymphocyte count (#Lymphocyte) were significantly lower in infertile women compared to fertile controls (p<0.05). These haematological parameters however did not correlate significantly with any of the autoantibodies in either infertile cases or controls. Infertility among Ghanaian women is associated with TPO-abs and APL-abs positivity therefore these antibodies may be screened as part of routine checks for appropriate intervention. However, these autoantibodies may not be directly associated with a history of spontaneous abortion. BMI, NLR, PLR, #NEUT, and #Lymphocyte do not correlate with the presence of autoantibodies in Ghanaian infertile women.
A thesis submitted to the Department of Molecular Medicine, School of Medical Sciences in fulfilment of the requirements for the award of Master of Philosophy in Immunology.