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Causes and Treatments of Auto-Immune Related Pregnancy Loss
February 9, 2013
Our bodies contain genes called Human Leukocyte Antigen (HLA) genes which help the immune system to distinguish between the body’s own proteins and proteins of a virus or bacteria. When a foreign protein is detected, our immune system kicks in to defend us, as in the instance of having a cold or the flu.
Some couples trying to conceive may be diagnosed with immunologic incompatibility, or allogeneic issues, which are detrimental to their fertility. Genes from both of the parents that are passed on to their growing embryo may not properly communicate to the mother’s immune system and her body may mistake the embryo as a foreign invader. As a result, the embryo may not implant or may miscarry.
Diagnosing Immunologic Infertility
Jeffrey Braverman, M.D., F.A.C.O.G., of Braverman IVF and Reproductive Immunology in New York, says a number of factors can impact a woman’s ability to carry a healthy pregnancy. “Predisposition to immunologic abnormalities such as auto immune disease, abnormal development of ‘inflammatory’ cytokines in [the mother’s] blood, elevation of activated immune cells, immune response to proteins in sperm, or failure to generate protective cells that a mother makes when pregnant can be associated with improper immune tolerance in the mother for the embryo.” Celiac disease, Crohn’s disease, Multiple Sclerosis, Polycystic Ovarian Syndrome (PCOS), Endometriosis, and Lupus are all examples of conditions that can lead to rejection of an embryo if not properly treated. Stress and dietary factors may also play a role in the mother’s immune tolerance of the pregnancy.
However, doctors can treat the patient to create a tolerance to the embryo’s proteins. Dr. Braverman states the most accurate method of diagnosing a couple with immune intolerance is via a full blood work panel and reproductive history. Endometrial biopsy is also performed in some practices, though Braverman finds the resulting data to be inconclusive. “To date [endometrial biopsies] are almost of no relevance as the cells that are looked at are not specific enough and their function is not elucidated,” he says.
Preventing Auto-Immune Pregnancy Loss
Dr. Braverman says patients who suffer from recurrent pregnancy loss should first be sure there are no genetic causes of the miscarriage. If a genetically sound embryo, as determined by PGD before embryo transfer or analysis of tissue after a miscarriage, does not develop into a healthy pregnancy, the patient should consider immune testing to determine if there is an underlying immunological cause of pregnancy loss. “By identifying the likely source of the problem, treatments can be given that help to correct [them]. The goal is trying as much as possible to assist in the immune tolerance that must be created…most important is that we have ruled out genetic issues as the 'only' cause for the failures and miscarriages. Once this is done we can focus on the immune system as one of the most likely causes of the failures or losses.” Without generating immune tolerance in these patients, the immune system will attack the embryo much like an organ transplant patient who suffers rejection of the organ and this can occur at any time during the pregnancy.
Fertility patients who have suffered pregnancy loss as a result of immune system intolerance are often prescribed a protocol of diet modification and steroids, among other medications, to help reduce the body's defensive response toward the embryo. Some of these include: Probiotics, Prednisone, Lovenox, Intralipids, Humira, IVIG, and Neupogen.
Dr. Braverman advises patients who have not gotten pregnant with high quality embryos, those who have experienced miscarriage of a genetically normal fetus or have suffered a loss after the heart beat has been detected, and those with a family history of auto-immune diseases and miscarriage to seek a consultation with a reproductive immunologist, or fertility doctor who specializes in immunologic causes of infertility.