A Complete Guide to Reproductive Immunology

The concept of reproductive immunology is not widely accepted by all physicians. Those patients who have had repeated miscarriages and multiple failed IVF's find themselves exploring it's possibilities as the reason. With an increased amount of success among treating any potential immunological factors, the idea of reproductive immunology can no longer be overlooked.

The failure to conceive is often due to immunologic problems that can lead to very early rejection of the embryo, often before the pregnancy can be detected by even the most sensitive tests. Women can often produce perfectly healthy embryos that are lost through repeated "mini miscarriages." This most commonly occurs in women who have a conditions such as endometriosis, an under-active thyroid gland or in cases of so called "unexplained infertility." It has been estimated that an immune factor may be involved in up to 20% of couples with otherwise unexplained infertility. These are all conditions where abnormalities of the woman’s immune system may play an important role.

A woman’s ability to successfully maintain a pregnancy is to a large extent dependent upon a complex interplay of sophisticated immunologic adjustments designed to convert her uterus into a host for the developing embryo, the developing fetus and its placenta from rejection. Sometimes these mechanisms can go wrong and, depending upon how and when this happens, the woman might experience recurrent miscarriages, infertility, or failure to conceive following IVF

The indications for testing are:

  • Two miscarriages or two IVF or GIFT failures after age 35 or three miscarriages or IVF or GIFT failure before age 35
  • Poor egg production from a stimulated cycle (less than 6 eggs)
  • One blighted ovum
  • Unexplained infertility
  • Previous immune problems (ANA positive, rheumatoid arthritis, and/or lupus)
  • Previous pregnancies that have shown retarded fetal growth
  • One living child and repeat miscarriages while attempting to have a second child

Tests used in the immunological screening and the treatments upon findings:

  • IVIG Treatment Screen
  • Day 3 Inhibin B
  • Anti-Phospholipid Antibodies (APA)
  • Anti Cardiolipin Antibodies (ACA)
  • Natural Killer Cells
  • Anti-Ovarian Antibodies (AOA)
  • Anti-Sperm Antibodies (ASA)
  • Lupus Anticoagulant (LAC)
  • Anti-Nuclear Antibodies Screen (ANA)
  • Anti-Microsomal Antibodies
  • Leukocyte Antibody Detection (LAD)
  • Embryo Toxic Factor (ETF)
  • Sperm Penetration Assay (SPA)
  • Acrosome Reaction (MCP, CD46)
  • Chromosome Analysis

Therapies and treatments used:

  • Aspirin
  • Heparin
  • IVIg
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