Everything you need to know right now about immunology and fertility

At The Ribbon Box, we believe in getting expert insights on the topics that matter most to you. When we recently ran a poll on what you wanted to learn more about, immunology and its impact on fertility came out on top.

To bring you the latest insights, we spoke with the brilliant team at IVF Spain. Dr Rogel, one of their leading specialists, answers your key questions below.

What is immunology and how is it connected to fertility?

Immunology is a branch of medicine that focuses on how the immune system functions, diagnosing potential disorders and developing treatments. Over the years, reproductive medicine has advanced significantly, but some patients still experience recurrent miscarriages or implantation failure, even when everything seems optimal—good embryo quality, a healthy uterus, and no detectable blood clotting disorders.

This has led fertility specialists to explore the role of immunology in pregnancy, an evolving field of research which has uncovered a range of immune-related conditions that could impact pregnancy, with ongoing studies aiming to further refine treatments.

Could an immune condition be affecting your fertility?

If you suspect an immune-related issue is affecting your fertility treatments, the Im Map test (Immunological Map) is a recommended first step. This test, performed via an endometrial biopsy and blood sample, analyses immune markers to determine if immunotherapy might be beneficial for your case.

Does rheumatoid arthritis impact fertility?

Autoimmune conditions, including rheumatoid arthritis, can trigger chronic inflammation, potentially affecting fertility in multiple ways. These may include:

• Lower egg quality
• Reduced fallopian tube mobility
• Impaired embryo implantation

Additionally, certain medications used to manage autoimmune conditions can negatively impact implantation or pose risks to fetal development. It’s crucial to work with a specialist to find the best approach for your fertility journey.

Should you undergo immune testing before your first FET?

In my opinion, no. If you haven’t yet had an embryo transfer, the likelihood of having an immune-related fertility issue is quite low. Medical testing should always be guided by a clinical need, as unnecessary testing can lead to false positives, unnecessary treatments, and additional costs.

Immunological testing is typically reserved for cases of recurrent implantation failure or repeated miscarriages.

Any other tests to know about?

If you’ve experienced multiple miscarriages or failed transfers, the following tests may be useful:

• Genetic testing – Parental karyotyping and preimplantation genetic testing for Aneuploidy (PGT-A) to identify chromosomal abnormalities.
• Coagulation screening – Tests for lupus anticoagulant, antiphospholipid antibodies, and coagulation proteins.
• Anatomical assessments – 3D ultrasounds, hysteroscopies, and Doppler flow studies to check for uterine abnormalities.
• Immunological testing – Assessment of natural killer (NK) cells, Th1/Th2 balance, and KIR receptors.

Optimal thyroid levels for fertility?

Subclinical hypothyroidism is a common yet often overlooked cause of implantation failure and recurrent miscarriage. Ideally, TSH levels should be ≤2 before undergoing fertility treatment, with T4 levels within the normal range.

How much does immunology testing cost?

At IVF Spain, the ImMap test currently costs €120 if done during your first clinic visit, or €220 if performed later.

Why are some people skeptical about immunology in fertility treatment?

Immunology’s role in reproductive medicine is still emerging, meaning not all theories have been fully validated by large-scale studies.

In evidence-based medicine, findings must be statistically significant across a wide patient population to be widely accepted. Since reproductive immunology is often explored in rare or complex fertility cases, some specialists remain cautious. As research progresses, clearer guidelines and treatment protocols will continue to develop.

Does immunology improve IVF success rates?

For the majority of patients, standard fertility treatments are effective without immunological intervention. However, in specific cases—such as repeated implantation failure or recurrent miscarriage—immunotherapy may enhance success rates.

Can you access immunology treatments abroad?

Yes. Immunological testing and treatments are not geographically dependent and can be coordinated remotely with specialists, ensuring continuity of care regardless of location.

A huge thank you to Dr. Rogel and the team at IVF Spain for sharing their insights on this rapidly evolving field. If you’re exploring fertility treatments and want to understand how immunology could play a role in your journey, you can book a FREE virtual consultation with the team at IVF Spain.