Recurrent Miscarriage: There’s lots of noise in the blogosphere with no science behind it
Recurrent pregnancy loss is a very frustrating condition, especially when the cause cannot be determined through testing. Immunological experts doctors Alecsandru and Garcia-Velasco of Carlos University in Madrid, Spain, recently pointed out in Human Reproduction that there is confusion regarding immune testing and treatment. There are basic autoimmune tests that are valuable, including the anticardiolipins test for cardiolipin antibodies that are often high in women with recurrent miscarriage, and others.
And then there are unfounded treatments wrongly promoted. Following are two of those.
1. Natural killer cells cause miscarriage
Experts in immunology feel that the simplistic idea that natural killer cells are an indicator of fertility or recurrent miscarriage is far off base. Patients often read the very weak claims in this area on the Internet. Some doctors offer treatments such as intralipids, so this type of clinical practice continues. Desperation and frustration should not drive treatment decisions.
The natural killer cells from the peripheral blood (PBNK) and uterus (UNK) are different types of immune cells. PBNK cells function as killer cells against viruses, tumors and damaged cells. Quite in contrast, UNK cells seem to be important in the development of a healthy placenta. We can consider them as good cells, and the number of PBNK cells has nothing to do with how many UNK cells are in the uterus. This information suggests that natural killer cells might not be the simple answer to recurrent miscarriage.
2. High numbers of some toxic cells cause miscarriage
This is the most recent story line about alloimmunity, which is immunity obtained from another agent against one’s own cells. This is another confusing idea, that women with recurrent miscarriage appear to have higher numbers of the “more cytotoxic” CD56dim and less of the CD56superbright cells.
This concept is completely without basis because the number of these cells varies according to the day of the menstrual cycle, stress, time of day and exercise. The immune treatments that have been suggested in the past have been debunked by careful study.
The American experts in immunology such as Dr. William Kutteh of Memphis, Tennessee, believe “too many pseudo-immune treatments have been cooked around IVF with a complete lack of real evidence, exploiting patients’ hopes and resources.”
In conclusion, the best solution for recurrent pregnancy loss in many cases is to have in vitro fertilization (IVF) with preimplantation genetic diagnosis to resolve the possibility that abnormal chromosomes are causing the problem. Some women produce high percentages of chromosomal errors and really need an egg donor.
