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Reproductive Immunology

Reproductive Immunology

Immunotherapy in Recurrent Miscarriages, Implantation Failures & Unexplained infertility.
Dr. Mohan Raut MDDGO, Dr. (Mrs) Mugdha Raut MDDGO
Immunotherapy Centre for prevention of Repeated Miscarriages, Santacruz (E) Mumbai.

Introduction

Recurrent Spontaneous abortions are detired as 3 or more consecutive spontaneous abortion it affects 0.5-1% of all women. In minority, parental chromosome abnormalities, uterine malformations or endocrine and thrombophilic disturbances may be the risk factors. However in 50-60% of these couples all these factors are normal. In these couples Immunological risk factors can be responsible for repeated miscarriages.

data

Why Immunology

This has been increasingly considered because

  1. Several studies of the immune interactions at the feto-maternal interface indicate an immunological background for many cases of Recurrent Miscarriages.
  2. Immune disease is often caused by immure reactions localized in target organs.

Foetus is considered as an allograft. The paternal antigens of the foetus are always protected from maternal immunological system by complex combination of Humoral (blocking antibodies and cell mediated Immunity. This protects the foetus from immunological rejection by mothers immunological system. However deficiencies in these protective mechanism lead to an immunological response against the embryo leading to abortion or even implantation failure.

Diagnosis of Immunological factor

The Immunological factor in Recurrent miscarriages can be confirmed by doing certain tests the tests are based on following observations..

  1. Endometrium of non pregnant patient on RM shows high concentration of Natural killer cells .
  2. Number of activated natural killer cells is increased in peripheral blood
  3. Certain cytokines ( immune molecules that control immune cells ) are found to be raised in patient with RM.

Role of Immunotherapy

Two Kinds of Immunotherapy are used in patients with RM & Implantation Failure
(A) Active Immunotherapy –
LIT or Lymphocyte Immunization Therapy.
(B) Intravenous Immunoglobulins.
(A) LIT:
Lymphocytes from husband or pooled Donor Lymphocytes are used to cause Immuno  modulation in the mother leading to prevention of repeated miscarriages.
LIT is more effective in primary aborters ( no live baby)
(B) Intravenous Immunologlobulin (IvIg) IvIg is used to prevent repeated miscarriages and is especially effective  in secondary aborters.

Risks of Immunotherapy

  1. LIT may be associated with minor side effects like pains and itching at injection site the risks of LIT have been exaggerated by some but a large study has reported a very low frequency of side effects .
  2. IvIg The possible risk of transmission of infections through IvIg is also minimal due to strict donor screening and virus inactivation procedures.

Worldwide Experience

Immunotherapy for RSA and Implantation Failure has been practiced across the globe. There are trials which have shown definite effectiveness of Immunotherapy in these cases ( Dr.O.B.Christiansen, Pandey Mk etc) A Cochrane metanalysis of relevant trials had concluded that LIT provide no significant beneficial effects However Dr O.B Christiansen in his analysis of cochrane review has proved that the mataanalsis was flawed and showed that LIT was in fact more effective in primary Aborters. Also effect of LIT increased with the number of previous miscarriages.

Availability of Immunotherapy

Recently Immunotherapy Foundation & Immunotherapy Centre for Prevention of Repeated Miscarriages was launched in Mumbai. Dr. O.B Christiansen was the guest speaker and in his speech he explained in details about various types of Immunotherapys and their effectiveness .

LIT is available at Immunotherapy Centre for Prevention of Repeated Miscarriages located at Santacruz (E), Mumbai A complete Immunological Profile work up is done prior to selecting couples for Immunotherapy. LIT is a day care procedure involving 4-6 hours of Hospital stay.

Conclusion

Repeated Miscarriages is a strattering experience for a couple. After treating the couples who have known risk factor a large number of couples remain in whom Immunological factor is responsible. A proper diagnostic work up followed by appropriate Immunotherapy can help these couples achieve their dream of having a healthy baby.

The Indian Experience

397 couples were given Active Immunotherapy. (LIT) These included couples with repeated miscarriages, & Implantation Failures (IVF). The success rate reported was 85%. This study has encouraged us to start ICPRM.   

Authored By Dr.Mugdha Raut, MD & Dr.Mohan Raut, MD

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The lyers went form clinic to clinic . They tried everything,including IVF. Nothing worked.But they were not the ones to give up hope! Finally,after 5 years of waiting,Nisha was born to them at our clinic.

An open letter from Dr Mugdha

Nisha is 21 now! she is hale and hearty; beautiful to look at and very very spirited. To me, she could have been no one other than that - knowing first hand how she was brought into the world.

It is beautiful story I love to tell,especially to those couples who have resigned to a life without a child.

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