Can Immunological Testing Detect Pregnancy Loss?
Frederick R. Jelovsek MD
Miscarriages are common. It is estimated that 1 million of the 6 million pregnancies each year in the U.S. end up as a miscarriage. Up to 5% of couples have 2 miscarriages in a row and about 1% of couples have 3 miscarriages in a row. This situation is often labelled as habitual abortion although a better term is recurrent pregnancy loss (RPL). Faced with this problem, couples are very susceptible to any treatment suggestions and recently there have been many different immunotherapies promoted as the answer.
In order to determine the usefulness of any new therapy, we must compare it to what would happen if no therapy was given. As it turns out, couples who have had 3 miscarriages in a row still have a 50-70% chance of having a live baby with no treatment at all. Most new immunological tests and treatments do not stand scrutiny when compared to the expected, no-treatment rates according to Scott JR, and Branch W: Immunology of early pregnancy loss. Contemporary Ob/Gyn 1998;43(6):40-56.
What are the standard diagnostic tests, in addition to history and physical exam that are recommended by most physicians?
Diagnostic Tests for Recurrent Pregnancy Loss*
|thyroid stimulating hormone (TSH)||to detect hyper or hypothyroidism|
|serum progesterone||to detect adequate corpus luteum function|
|parental (both) blood chromosome analysis||to determine if there might be a hereditary genetic cause|
|lupus anticoagulant||to detect antiphospholipid syndrome|
|anticardiolipin antibodies||to detect antiphospholipid syndrome|
|to detect anomalous shapes of the uterus|
|pelvic ultrasound||to detect fibroids or the uterus|
* - Two or more miscarriages and age more than 30 years old or 3 or more miscarriages and less than 30 years old.
Other tests such as antibodies to other antiphospholipids, nucleotides, histones, B-2 glycoprotein, thyroid and nuclear antigens are not proven scientifically but they seem to be promoted by many. Similarly, treatments that are directed against some of these unproven immune problems are also not established scientifically. It doesn't mean that there isn't a subset of patients that have these problems, but most studies that have been done have either not confirmed their efficacy or have not been studied.
Utilizing these unproven tests are not without harm. In the 1970's, "thousands of couples spent millions of dollars on tests for HLA compatibility, the presence of maternal leukocytoxic antibodies, and the absence of maternal blocking antibodies before these factors were found to be unrelated to recurrent pregnancy loss" (Scott 1998).
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