Immunotherapy May Bring Hope for Infertility Patients

Time and time again women experience the tragedy of pregnancy loss. It has become so prevalent that sometimes the rest of society shrugs it off as a common occurrence, and we don’t really connect with the woman’s devastating heartache of losing a child. We hear of miscarriages, but we seldom hear of the women who have carried their babies for five months until something goes wrong, again. Sometimes these women are delivering their first born child only to watch this tiny life die in their arms minutes to hours later.

For the most part it’s standard practice for the doctor to wait until after the third pregnancy loss to begin testing for causes. Doctors will typically check for chromosomal defects, hormonal problems or abnormalities of the uterus; however, when the losses cannot be attributed to any of these causes, the problem gets labeled as ‘Unexplained Infertility’ or ‘Unexplained Recurrent Pregnancy Loss.’ There is still hope though. Research is being done, and more test results are indicating that immunological factors may cause recurrent pregnancy losses. Intravenous Immunoglobulin Therapy (IVIG), although still considered controversial in its benefits to some, could bring hope and full-term babies to couples suffering from unexplained infertility.

Statistics indicate that 50-80% of recurrent pregnancy losses are the result of some form of immunologic cause, especially in women over 30 years of age. That’s a number to be taken seriously. With percentages in that range, it’s surprising that more testing and treatment options for pregnancy loss due to immunologic problems are not more popular and widely available. IVIG therapy is used today in cancer patients, and is covered by most insurance companies for that purpose. For the treatment for unexplained infertility, this therapy is still regarded as controversial and many insurance carriers will not cover the costs. The treatments are expensive, but for determined couples the results outweigh the costs. In many tests, the combined treatment of In-Vitro Fertilization (IVF) with IVIG Immunotherapy has resulted in 40-50% success rates in patients with previous failed IVF attempts.

To put it simply, the immune system works by identifying foreign proteins in the body and attempting to destroy what does not belong there. This is the way the body fights off diseases and bacterial infections. A cell is identified as belonging or not by identifiers called Antigens. When there are immunologic problems, certain antibodies present in a woman’s body (autoantibodies) can respond to her own proteins as if they were an illness; the proteins are attacked, and the pregnancy is rejected. Other antibodies (alloimmune) may reject proteins from the male. Both result in failure to achieve pregnancy or failure to maintain pregnancy. There are several different autoimmune and alloimmune problems that cause pregnancy loss and that can be identified and treated.

For both autoimmune problems and alloimmune problems Intravenous Immunoglobulin Therapy (IVIG) has proven remarkably successful. The theory behind this therapy is to introduce antibodies from several different sources – thousands in fact - into the woman’s bloodstream intravenously. The treatments continue for a specified duration throughout the pregnancy. The woman’s antibodies will remain busy attempting to fight off the invading immunoglobulin; too busy, in fact, to try to fight off the pregnancy. Clinical trials have shown the benefits of this treatment for the right patients and the treatments have been proven safe.1 As with any therapy, there are some possible side effects. The side effects include: infusion reactions (reactions to the foreign immunoglobulin introduced into the bloodstream), headache, preterm labor, ectopic pregnancy, intrauterine growth retardation and fetal abnormalities. These side effects are closely monitored and can be controlled with a change in brand and dosage levels.

Unexplained infertility doesn’t have to be the ‘end all’ in your diagnosis. Medically, there are more treatment options becoming available as research, testing and education continues. And, although financially there is a long way to go to make infertility treatments affordable to everyone, there are programs available to help those in need. The International Council on Infertility Information Dissemination (INCIID) offers a wide variety of support and information on infertility topics. They also offer pre-written letter templates to send to insurance companies who do not currently cover the cost of IVIG treatments. The National Fertility Association RESOLVE (www.resolve.org) also hosts a variety of educational information and links on infertility. There are many other resources available, and couples should be encouraged to read as much information as they can on the immunotherapy options.

Infertility is a heartbreaking disease, and recurrent unexplained pregnancy losses are even more so. With immunological factors representing between 50-80% of unexplained pregnancy losses, immunotherapy treatments should be viewed as a standard treatment option available to all. The success rates in clinical trials don’t lie. There is hope.

Resources:

1. Stricker MD, Raphael B., Steinleitner MD, Alex, Bookoff MD, Charles N., Weckstein MD, Louis N., Winger MD, Edward E. Successful treatment of immunologic abortion with low-dose intravenous immunoglobulin. Fertility and Sterility vol. 73, NO. 3, March 2000 American Society for Reproductive Medicine.
   
2. Coulam Carolyn B., Stephenson Mary, Stern J. Jaros, Clark David A. Immunotherapy for Recurrent Pregnancy Loss: Analysis of Results From Clinical Trials. American Journal of Reproductive Immunology 1996; 35:352-359
   
3. American Society for Reproductive Medicine (ASRM)
   
4. RESOLVE: The National Infertility Association
5. The International Council on Infertility Information Dissemination (INCIID)