Reproductive immunology
Repeated miscarriages and implantation failure after transfer of good quality embryos in IVF are the two biggest challenges in reproductive medicine. In the last decade, significant efforts have been made to ascertain possible immunological causes through reproductive immunology.
The failure of implantation, like continuous miscarriages, is not due to a single problem, so it is rather unlikely that a single solution will be found.
This issue remains controversial and tests of this type are not recommended as routine examinations. Tests for NK cells (natural cytocidalities) are not recommended for everyone who starts extracorporeal treatment, as in the majority of cases it is the genetic abnormalities of the embryo that cause the inability to implant.
However, new developments in tests and treatments in the field of reproductive immunology can at least help us exclude one of the variables that cause such emotional charge to these couples.
The prospect of testing for NK cells can be discussed with couples who have History of repeated failed IVF attempts and/or early pregnancy losses.
In addition, it concerns patients with a history of endometriosis and with previous failed IVF cycles, as well as those with a history of known autoimmune diseases (such as lupus, rheumatoid arthritis, Cron's disease, ulcerative disease colitis, chronic fatigue syndrome, etc.)
Number of NK cells (CD-69 activation index)
Women may have a significant number of NK cells but if they are not activated, they are believed to be rather unlikely to adversely affect the reproductive process. In our practice we measure the levels of "active" NK cells bearing the CD-69 activation index and, if increased, have a proven negative effect on the outcome of the pregnancy.
Measurement of cytotoxicity of NK cells
We also directly measure how toxic the NK cells are by joining them with Pregnancy-like TISSUE in our laboratory and measuring "cytotoxicity" levels. If the number of NKs or cytotoxicity is high, we consider the possibility of immunological therapies.
Examination for the treatment of cytotoxicity of NK cells
The second step in measuring cytotoxicity includes the available therapeutic solutions (intravenous immune globulin, steroids, or intralipid) to determine whether the lethal effect of NK cells can be inhibited by medication. This stage of the examination helps us to arrive at the treatment we will recommend.
Measuring cytokines (Type Th1,Th2)
TH1 and TH2 cells are cells of the immune system whose balance is vital for maintaining pregnancy. If the patient produces an excessive number of Th1-type cells, this can also reduce the chances of successful implantation and may have to be treated with immunosuppression.
Thyroid antibodies
Some women produce an antibody (antibody against thyroid peroxidase or TPOAb), which can affect the production of hormones by the thyroid gland. Research shows that patients with high levels of TPOab or problematic thyroid function are at a much greater risk of miscarriage.
In our clinic, we recommend that all patients check their thyroid function before starting IVF treatment and fertility therapy, and in the case of some patients, TPOAb diagnostics may be appropriate. Once an abnormality in thyroid function is found, thyroxine treatment during IVF has been found to reduce the chances of miscarriage.
HCG receptor autoimmunity
HCG is a hormone that is produced during the early stages of pregnancy and there is evidence that it causes the natural suppression of the immune system to help implant the fetus in the womb. There is a theory that advocates that the presence of maternal antibodies against the hCG hormone or its receptor can affect implantation, leading to conception failure or miscarriage.
In the majority of cases, when an IVF fails or a woman miscarries, the cause is associated with the fetus.
However, if a couple makes repeated failed attempts with good quality embryos (repeated implant success-RIFs) or the woman has repeatedly miscarried, the causes should be investigated further in order to minimize the physical and mental strain of the couple and make sure there are no treatable causes.
In couples with repeated implant failures, the exact time when these tests should be performed will depend on various factors such as age, fetal quality and number of failed cycles.
Although some argue that in the case of continuous miscarriages, tests are only necessary if at least three miscarriages have preceded, Studies show that the same number of treatable causes can be diagnosed when the couple goes through a checkup after two. Therefore, taking into account factors such as age again, we may recommend that you take tests at that point in time.
IVF
