Immunotherapy for recurrent pregnancy loss

Research output: Contribution to journalReview articlepeer-review

Abstract

When immunomodulation is used on an unselected population with recurrent miscarriage (RM), there is no improvement in the live birth rate. However, when the population is selected for a poor prognosis, or immune phenomena, immunotherapy has been shown to be effective. This review discusses four immunomodulatory agents, namely, paternal leukocyte immunization, intravenous immunoglobulin (IVIg), intralipid, and filgrastim. The presence of embryonic aneuploidy may confound the results of treatment, therefore creating an impression of futility when treatment may be highly effective in saving pregnancies that can be saved. Additionally, in an unselected population with RM, there is a relatively good prognosis of 60–80% for a subsequent live birth depending on whether the definition of ≥2 or ≥3 miscarriages is used. Hence, spontaneous prognosis must be taken into account, which has not been the case in previous trials. This review discusses the possible immune-mediated mechanisms of pregnancy loss and the means whereby immunotherapy may modulate these mechanisms.

Original languageEnglish
Pages (from-to)77-86
Number of pages10
JournalBest Practice and Research in Clinical Obstetrics and Gynaecology
Volume60
DOIs
StatePublished - Oct 2019
Externally publishedYes

Keywords

  • Filgrastim
  • Intralipid
  • Intravenous immunoglobulin
  • Paternal leukocyte immunization
  • Recurrent miscarriage

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