Study identifies potential to predict risk in patients with diminished ovarian function based on immune status

[reporter Jang Jong-ho] A study has found that the factors regulating ovarian function differ depending on whether anti-ovarian antibodies (AOA) attacking the ovaries are present.

The study, conducted by a team led by Professor Han Ae-ra at Daegu CHA Fertility Center, is expected to help predict risk and determine treatment strategies based on the immune status of patients with diminished ovarian function. The findings were published in the latest issue of the international journal Journal of Autoimmunity.

The body’s immune system protects it by attacking harmful substances such as bacteria and viruses. However, when the immune system malfunctions, it can mistakenly identify and attack the body’s own healthy tissues. Anti-ovarian antibodies are antibodies that may appear when the immune system attacks the ovaries. They are known to be found in up to approximately 30% of patients with premature ovarian failure of unknown cause.

Professor Han’s team studied 803 women who had not begun any treatment related to reproduction. The participants were divided into 668 women without anti-ovarian antibodies and 135 women with the antibodies. The researchers compared their hormone levels, blood glucose, inflammatory markers, and immune-cell status.

The research team also analyzed AMH levels, which indicate ovarian function. AMH indirectly reflects the number of eggs remaining and is commonly called an “ovarian age test.” AMH levels generally decline with age. To reduce the effect of age on the findings, the researchers used an “age-adjusted AMH ratio.” This allowed them to examine how factors other than the natural age-related decline in AMH affected ovarian function.

The analysis showed that women without anti-ovarian antibodies had relatively well-balanced immune regulation in response to changes in the ovarian environment.

By contrast, women with anti-ovarian antibodies had an impaired immune balance, along with chronic inflammation and metabolic abnormalities. Five factors were found to be closely associated with ovarian function: homocysteine, which is linked to chronic inflammation; the Th1-to-Th2 ratio, which reflects immune balance; glycated hemoglobin (HbA1c), which indicates average blood glucose levels over the previous two to three months; PAI-1, which is associated with blood clot formation; and vitamin D deficiency. When the risk of premature ovarian failure was predicted using age alone, the predictive performance was 0.70. After the five immune and metabolic indicators were added, it increased to 0.786.

This study suggests that diminished ovarian function in women with anti-ovarian antibodies may not be caused simply by aging. It indicates that systemic inflammation and the body’s overall immune and metabolic status may also affect ovarian function. Therefore, patients who test positive for anti-ovarian antibodies should have their overall health assessed, including inflammation, blood glucose, and vitamin D levels, rather than having their ovarian function examined alone.

Professor Han Ae-ra said, “This study confirmed the potential to predict the risk of diminished ovarian function more precisely according to a patient’s immune and metabolic status.” She added, “For patients with anti-ovarian antibodies, an approach aimed at reducing chronic inflammation and restoring metabolic balance may help protect ovarian function.”

However, this study identified an association between immune and metabolic indicators and diminished ovarian function. Further research is needed to determine whether specific immune therapies can actually restore ovarian function. Meanwhile, after completing a training program in the United States, Professor Han Ae-ra resumed seeing patients at Daegu CHA Fertility Center in September.

Jang Jong-ho, reporter bellho@

This article has been translated by GripLabs Mingo AI.

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