4. Future research

Presence of AAbs is hallmark of autoimmune disease with no clarity on their role in disease pathogenesis and ensuing AI. With few exceptions these are not organ-specific indicating them to be NAbs [148–151]. Obtaining clarity on role of AAbs will guide further treatment modalities for patients with AI [93, 101, 152]. Global high dose immunosuppressive therapy seems to be the only effective option for autoimmune reproductive failure despite its shortcomings [153, 154].

Targeted interventional therapy by inducing antigen-specific tolerance is another option [155, 156]. Till such a time as a definitive therapy is available, pan autoimmune disease diagnostic panels can be designed using autoantigenic targets (recombinant proteins or peptides) such as β2-glycoprotein I and HSP90β (EP6) [151, 157–159] followed by management with corticosteroid therapy. A loss of reactivity to key autoantigens (predetermined to affect ovarian function) would serve as biomarkers to better manage immunosuppressant therapy.
