Immune Testing for Recurrent Miscarriages & IVF Losses

If you and your partner have been trying to conceive but have had repeated miscarriages or IVF failures, it can be one of the hardest and most draining experiences of your lives. Even more painful is how no investigation on the matter provides a concrete answer as to why it happens, despite all the advances in this field. In fact, studies suggest that around 50% of recurrent pregnancy losses remain unexplained even after thorough evaluation.

That said, what if the reason behind your continued losses isn’t something vague-sounding like egg quality or hormone levels but your immune system, the very thing that is meant to protect a mother and her baby? Reproductive immunology, an emerging field on the matter, aims to investigate the same. To answer what exactly this field entails, let us unpack everything there is to know about it and find out how it may offer some clarity to couples stuck in the limbo of pregnancy struggles.

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Understanding reproductive immunology

Pregnancy is a sensitive and complicated process, more so than what may appear on the surface. After all, your body is pushed into accepting the embryo, which carries a genetic mix of both the mother and the father and is technically a foreign object. Your immune system is then tasked with adapting to protect both the mother and the embryo throughout the pregnancy process.

Typically speaking, the immune system faces little difficulty during the adaptation process. In some people, however, the immune system struggles to make the shift and ends up treating the embryo as a threat. Unfortunately, this can be harmful during a pregnancy, and is exactly what reproductive immunology aims to investigate.

Reproductive immunology is a growing area of fertility medicine that lets a couple know if the mother’s immune responses are disrupting implantation or early development. While it holds a lot of promise, it’s worth noting that many clinics only offer these tests in specific cases, such as after multiple IVF failures or recurrent miscarriages and only through specialists trained in this field.

How is the immune system’s interference in pregnancy identified?

Medical professionals who specialise in immune testing look at several markers. The first and most prominent one is the number and nature of natural killer cells. These are immune cells that play a substantial role in fighting infection within your body. However, overly aggressive NK cells are known to interfere with the embryo’s implantation process. Second on the list is the Th1/Th2 cytokine ratio, which essentially shows how balanced your immune signals are. If there’s a tilt towards Th1, your immune system may be trying to fight inflammation within the body, which isn’t an ideal situation for a recognised pregnancy.

Next, the doctors may also look for autoimmune antibodies within your body, which may cause blood clotting or impair how the placenta develops, both of which massively raise the risk of a miscarriage. The last, and least routinely practised, is the HLA compatibility testing, in which you and your partner are essentially tested for similar immune gene markers. If there’s too much similarity, your body might not be reacting to the pregnancy correctly and may fail to support the development of the embryo.

What’s important to note is how there are a lot more tests when testing an immune system’s role during pregnancy, and you’re not expected to know which tests to take. A fertility specialist will usually recommend a custom panel based on your medical history, especially if you’ve had multiple losses or unexplained IVF failure.

When to consider immune testing

Put simply, as soon as you can. Generally speaking, people are only offered immune testing after two or more miscarriages. But if you’ve been through IVF with high-quality embryos and still walked away with a loss, bringing up an immune test and subsequent treatment may just be worth it, especially if your hormones, general anatomy, and egg quality look okay on paper.

The same goes for a diagnosed autoimmune condition like lupus, Hashimoto’s, or rheumatoid arthritis. Not only do these conditions affect your joints and put your immune system into overdrive, but they also have subtle effects on reproductive health that may not even be noticeable at first. Finally, if your instincts keep ringing over this and all prior diagnoses have come clean, try to get a green light for the test from your doctor. Being thorough is better than being in the dark, after all.

Types of immune treatments available

Now, say the test results show that your immune system is indeed the culprit behind your pregnancy struggles. In that case, there are enough treatments out there to cover just about any immunological issue that you might be facing. The first step, then, is to find a fertility clinic that specialises in immune treatment for IVF or regular pregnancies. Next, based on your immune test results and medical history, your fertility specialist will guide you through a personalised immune treatment that’s best for you. If you want to know more, here are some of the more commonly used treatments that you can expect to receive in the fertility clinic:

Intralipid or IVIg Infusions

Both Intralipid and IVIg infusions are used to help calm down overactive natural killer (NK) cells, which, as mentioned previously, can get in the way of implantation. Usually, these are given before embryo transfer and then again if pregnancy occurs. Your doctor will guide the schedule based on your test results and overall risk.

Clexane and Baby Aspirin

If blood clotting or poor blood flow to the uterus is suspected, Clexane, a blood thinner, is often prescribed as a daily injection. You’ll usually take it from the early days of your cycle, skipping it only on egg collection day. Low-dose aspirin is often prescribed alongside Clexane to improve uterine blood flow.

Progesterone Support

In immune-related infertility, your body might not respond well to progesterone. As a result of this, you may receive progesterone injections as part of the treatment. This one often continues until 12 weeks of pregnancy or longer, depending on your needs.

Lymphocyte Immunisation Therapy (LIT)

LIT is recommended when a woman has very low levels of specific protective antibodies that help with embryo tolerance. The treatment involves injecting white blood cells into your forearms, just under the skin. It’s a simple outpatient procedure done in two sessions spaced a few weeks apart.

Metformin

Metformin is commonly prescribed to people with PCOS or insulin resistance, as it helps balance blood sugar levels and supports ovulation. It’s taken as a daily tablet and is especially helpful if weight or irregular periods have been a concern.

Understandably, reading about all these treatments may leave you with a sense of hope. While that’s undoubtedly a positive, it must be reiterated that every single case of fertility is unique and requires a high level of personalisation. So, before giving yourself the go-ahead for any of the options above, please make sure to consult with a qualified healthcare provider familiar with your individual needs and medical history.

The path forward

It’s a hard ask to keep up hope after a loss. What’s harder still is to maintain trust in your body, your partner, your doctors, and everything else. Fortunately, immune testing doesn’t ask you to place blind faith in some process that shoots arrows in the dark. It’s a thorough procedure that can potentially help you understand why your body might really be rejecting a pregnancy.

If nothing else, it gives you the invaluable information you may have been looking for, and in a world where unexplained infertility can feel unbelievably cruel, it’s the kind of progress that every to-be mother deserves. So, if you still find yourself on the lookout for answers, consider enrolling yourself for immune testing to take smarter steps and carry out a successful pregnancy.