Anti-Nuclear Antibodies (ANA) in Reproductive Health: ANA Positive? Here’s What It Means

While the anti-TPO test focuses on thyroid health, ANA (antinuclear antibodies) is another critical marker in autoimmune-related fertility issues. Here’s how it ties in:

What is ANA, and how does it matter?

ANA stands for anti-nuclear antibodies; that means that it is going to be testing for antibodies, which are going to be produced against a wide range of cells in the human body.

Because all the cells in the body contain the nucleus, and these are the antibodies directed against the nucleus.

Actually, ANA encompasses a very broad spectrum of autoimmune diseases. A good amount of variety of patterns is visible in the spectrum of ANA. There could be a nucleoid. There could be speckled and heterogeneous anti-antibodies, which can be identified as a part of the spectrum of ANA. 

Whenever a patient tests ANA positive, as far as the titer is concerned, in my clinical practice as a reproductive endocrinologist. I also very strongly recommend testing for other causes that may cause a pregnancy loss or an implantation failure, typically the testing for APLA, anti-cardiolipin antibody, and anti-beta 2 glycoprotein.

ANA is typically reported in the form of titers. Any value of ANA more than 1:80 is considered to be clinically significant, and further action and testing are required. This is recommended as a part of our immunological evaluation protocol. Titers less than 1:40 are considered to be clinically insignificant, and in repeat testing, they are not found to be clinically relevant. 

Any value of ANA more than 1:160 mandatorily requires further evaluation and treatment.

It has been proven in multiple studies, and that too with large-scale data, that women who are left untreated for ANA may experience early abortions as well as implantation failures.

As a result of this, it is extremely important and prudent to treat all these women who are ANA positive and treat them very effectively in order to make sure that the long-term outcome is not compromised for their reproductive health.

Patients with low AMH and endometriosis also have elevated ANA values. Consider specifically evaluating these patients also for these diseases

The typical therapy for the patient is going to include a combination of HCQS plus Wysolone, which is a steroid in combination with aspirin, and when indicated, a low molecular weight heparin.

The therapy is typically started for the patient approximately 2 to 3 months prior to a planned conception.

The same thing happened before an embryo transfer for a patient who had experienced previous failed IVF cycles. The entire therapy can be continued for approximately 12 to 18 weeks of gestation, and in some cases where it is indicated, up to 34 to 35 weeks of gestation.

All the drugs are considered to be extremely safe, even if the patient is pregnant, and do not interfere with or affect the growth and development or the neurological development of the fetus in any negative manner. ,

Further to this, if there is a specific antibody is found on evaluation, then the treatment is to be curated and added based on the protocol for that particular disease.

For all the members and patients who are interested in watching this, we have posted a beautiful masterclass about this on our YouTube channel. 

Interested members can also go through the flowchart diagram, which I have explained in the practical aspects of managing a patient who is ANA positive.