If you have suffered from recurrent pregnancy loss, you may have an immune system disorder that is preventing a pregnancy from continuing. Early pregnancy is fraught with obstacles and may be prevented by the vaginal environment, poor implantation, blood disorders, the condition of the eggs or sperm and even the couple’s immune systems.
What is Recurrent Miscarriage?
Recurrent miscarriage is when a woman has three or more miscarriages in a row, so if you’ve had two children, then a miscarriage, then another child followed by two more miscarriages, you haven’t suffered from recurrent miscarriage. They have to be concurrent.
Treatment for Recurrent Miscarriage
Treatment depends upon the cause of pregnancy loss. If a chromosomal disorder of the embryo is suspected, a couple may be offered pre-implantation genetic diagnosis (PGD), where cells are removed from a fertilized embryo to check for genetic abnormalities and only healthy embryos are put back. If abnormal sperm are causing the problem, Intracytoplasmic sperm injection (ICSI) can be performed, where a single healthy sperm is selected and injected directly into the egg.
If the eggs are of poor quality, using donor eggs may be suggested. If there is a blood clotting disorder, you will be given blood thinners to take during your pregnancy to prevent a miscarriage.
Sometimes the cause is not known or the couple’s immune systems are incompatible. If an immune problem is thought to be the reason, immuno therapies can be given. Intravenous immunoglobulin has been shown to be helpful in some cases, although the evidence for it is fairly weak.
What is Intravenous Immunoglobulin?
An immunoglobulin is an antibody. Antibodies are given intravenously in order to strengthen the immune system of the individual. These antibodies are taken from the blood of human blood donors.
Are there Side-Effects?
Short term use such as that given for recurrent miscarriage does not usually have side-effects, although there may be side-effects if the treatment is done on a longer term basis. These include:
- Anaphylactic shock
- Renal failure
- Venous thrombosis
- Pulmonary edema
- Dermatitis
- Headaches
- Meningitis
- vCJD – currently the medical profession do not screen for new variant CJD so it is possible to contract this prion disease via blood, although doctors aren’t sure how likely this is.
Will Intravenous Immunoglobulin Therapy Help?
Possibly. There are no guarantees. Some studies have shown it to be beneficial to women with immune system problems. A report in Clinical Reviews in Allergy and Immunology, said
‘Intravenous immunoglobulin (IVIg) has been used to prevent pregnancy loss. When used on an unselected population with recurrent miscarriage, IVIg has not been shown to improve the live birth rate. When patients are selected for poor prognosis or autoimmune phenomena, IVIg has been shown to be effective’
A review in the International Journal of Obstetrics and Gynaecology found that it was effective for women experiencing secondary recurrent miscarriage (where they managed to achieve a healthy pregnancy first time around and then subsequently suffered repeated miscarriages). However, there was no evidence to suggest it worked for women with primary recurrent miscarriage.
Of 442 women treated, there was no significant increase in live births but the rate was drastically increased for those with secondary miscarriages.
However, a more recent review found no benefit at all to either group of women:
‘A beneficial effect of IVIG in treatment of RM was not observed. Given the absence of a proven mechanism of action, and the lack of a diagnostic algorithm to identify patients who are likely to benefit from such treatment, IVIG administration for treatment of recurrent miscarriage is not justified outside the context of properly designed RCTs’.
Given the weak and contradictory evidence, it is really up to you, in discussions with your fertility specialist, whether you wish to proceed with this treatment.
Sources
- Intravenous Immunoglobulin and Recurrent Pregnancy Loss, Clinical Reviews in Allergy and Immunology, December 2005.
- Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review, BJOG: An International Journal of Obstetrics and Gynaecology, February 2007.
- A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage, Fertility and Sterility, March 2011.
Joanna Karpasea-Jones - I have been a health writer since 1997 when I published my own newsletter, SHOTS. I have written 2 books on childhood health, and write ...
