Reproductive immunology in Saudi Arabia: An emerging subspecialty of internal medicine

Reproductive immunology is an emerging field of medicine that examines the interplay between a woman’s immune system and her reproductive system during conception and throughout pregnancy (Genest 2023).[1] This new science aims to determine if the mother’s immune system is modified to accept or prevent embryo rejection. A reproductive immunologist is a physician with a certification in internal medicine, allergy, and clinical immunology, followed by further training and certification in reproductive immunology. The following are some approaches that reproductive immunologists can use to help women with unexplained infertility: Collaboration and teamwork with other specialists: Reproductive immunologists collaborate with other fertility specialists such as endocrinologists, obstetricians, and genetic counselors to offer comprehensive care for women experiencing unexplained infertility. This multidisciplinary approach makes sure that all aspects of fertility and pregnancy are addressed Investigation of immunological factors: Reproductive immunologists diagnose immune-related factors causing unexplained infertility in women by performing several laboratory tests, exploring hidden asymptomatic immunological abnormalities such as antiphospholipid syndrome, autoimmune thyroid disorders, and antinuclear antibody-associated diseases (Koshak 2022, Koshak 2023)[2,3] Treatment planning: Once immunological factors are identified, the reproductive immunologists develop personalized treatment plans, including medications such as antiprostaglandin, corticosteroids, immunosuppressive agents, intralipids, or intravenous immunoglobulin, to modulate the immune response (Genest 2023, Bunjer 2023)[1,4] Overseeing recurrent pregnancy loss: A reproductive immunologist conducts multiple laboratory investigations to identify immune factors causing recurrent pregnancy loss, miscarriages, stillbirths, and premature labors, and recommends immunopharmaceutical interventions to improve pregnancy outcomes (Koshak 2022, Banjar 2023, Koshak 2023).[2,3,4] Support of recurrent in vitro fertilization (IVF): For women undergoing repeated IVF, reproductive immunologists can optimize embryo implantation chances for women undergoing repeated IVF by implementing immune-modulating treatments to reduce recurrent failures or miscarriages due to abnormal immune responses (Genest 2023)[1] Preconception counseling: Reproductive immunologists provide preconception counseling for women with known immune disorders or unexplained fertility issues, advising on immune system optimization and reducing the immunological risks during pregnancy (Koshak 2023). Over the years of my clinical practice, I have managed numerous women with unexplained infertility referred from an infertility specialist to explore any potential immune causes and immunomodulatory therapeutics with successful pregnancy outcomes. The Kingdom of Saudi Arabia recently witnessed the arrival of a few internationally trained reproductive immunologists who returned to the country after completing their training and certification. Overall, reproductive immunologists play a vital role in diagnosing and managing immune-related factors that contribute to infertility, helping women achieve successful pregnancies and healthy infants.