We have learned much about infertility and pregnancy losses in the last 35 years by studying healthy couples who get pregnant easily and then lose every pregnancy through miscarriage. (See: Studies on Immune Problems and An Introduction to Dr Beer). Embryos are immunologically rejected and each attempt at pregnancy makes the problem worse. This occurs even when beautiful embryos are produced in the test tubes following in vitro fertilization. (See: Introduction to the Immune System).
A Typical patient:
A typical reproductive immunology patient averages 38.6 years old plus or minus 2 years. They have been unsuccessful 4.4 plus or minus 2 times and are often near the end of their reproductive life. Most of them can be helped through careful clinical history and specific laboratory testing. If an immune problem is identified, physicians may be able to provide them with successful immune therapies.
Immune Problems identified by laboratory testing:
Research shows that there are many categories of immune problems that can cause pregnancy loss, IVF failures and infertility. Here is a summary of the most relevant testing:
A. Antiphospholipid Antibodies (APA). These are the glue molecules for implantation and placentation.
B. Antinuclear antibodies (ANA). Some women develop antibodies to the baby’s DNA or DNA breakdown products and this problem is reflected by a positive Anti-nuclear antibody test (ANA). This is often with a speckled pattern. We also advise that women to have testing for double-stranded DNA, single-stranded DNA, polynucleotides and histones.
C. Natural Killer (NK) Cell Assay. This test determines the killing power of a woman’s Natural Killer Cells in the test tube. Elevated NK numbers and/or NK activity can be associated with increased risk for infertility and loss. Additional testing that helps to define this issue is the: Reproductive Immunophenotype.
D. Th1 Th2 Assay
The immune system is balanced between a TH1 (autoimmune) and TH2 (pregnancy or suppressive response). TH1 predominance can also be associated with reproductive failure. The can help us determine a patient’s risk for this problem.
E. T regulatory cell (“Treg”)
Higher numbers of Tregs in the blood have been associated with better pregnancy outcome. We at the center are now studying Tregs both in endometrial biopsies and in the blood of patients before and following therapy.
Thrombophilia is increased tendency to clot. Throughout an entire normal pregnancy, the mother’s ability to produce blood clots in the uterus and the placenta is suppressed. However, in some mothers, this clotting tendency is not suppressed sufficiently. This can contribute to many pregnancy complications. Physicians may request additional tests to confirm a suspicion that patients have other conditions that result in thrombophilia.
Patients undergo testing may wish to read these helpful documents: Treatment Protocol and Service Pricing Protocol. In addition, they may wish to visit our Network with Others page and the Reproductive Immunology Support resources site for patient support and fellow patient experiences. Lastly, there are many additional Online Resources we recommend for general education about reproductive immunology.