Recurrent miscarriage

Additional Reading

References for: Causes, evaluation, and treatment.

Medscape Women’s Health 1998 May;3(3):2 (ISSN: 1521-2076) Bick RL; Madden J; Heller KB; Toofanian A

Thrombosis Clinical Center, Department of Medicine (Hematology & Oncology), Presbyterian Hospital of Dallas, Tex., USA.

Immune Testing

Once you have achieved a pregnancy that results in either an arrested pregnancy or a spontaneous abortion it is wise to undergo immune testing to determine whether there is an underlying immunological condition preventing the pregnancy from continuing. Testing is recommended for those couples that have undergone multiple IVF cycles without success.

The following blood tests are recommended for the female:

test for anticardiolipin antibody, if positive, usually treated with 1 baby aspirin a day
test for antinuclear antibody, a titre over 1:40 is cause for concern and is treated with Prednisone, usually 5 mg twice a day on day one of the menstrual cycle and increased to 10 mg twice a day at the time of a positive pregnancy test and continued for at least 12 weeks of pregnancy. Follow-up blood tests may be needed.
test for antiphospholipid antibodies, if positive, treated starting on day 6 of the menstrual cycle with either Heparin injections, 5,000 units once a day or Fragmin injections, 2500 units once a day and continued until at least 12 weeks of pregnancy. Fragmin is preferred because it causes less stress on the body. Follow-up blood tests may be needed.

In addition the couple should be tested for HLA compatibility, also known as DQ-Alpha testing. This determines whether the couple is so similar that the female’s immune system does not produce protective antibodies to protect the fetus because her body does not recognize the cells arising from her partner as foreign. The treatment for this condition is Lymphocyte Immune Therapy or LIT. This is a paternal white blood cell immunization from the male to the female. This helps to stimulate the protective antibody reaction. The immunization is done subcutaneously on the forearm of the female partner. This is usually repeated at the time of a positive pregnancy test.

Note: as of January 2002 the US FDA has put a suspension on LIT treatment to determine its efficacy. Contact the Beer Clinic for further instructions, which most likely will include IVIG treatment (see below).

There are other blood components that can cause problems but if the above treatment is followed the combined effort is usually enough to combat the remaining components. The treatment is successful 75-85% of the time depending on the combination of problems. But sometimes the female partner has cells in her body that attack the fetus independent of the other antibodies. These cells are called Natural Killer Cells, CD 56+, and CD 19+5+ cells.

In the event that these cells are present in higher than normal limits, there is a treatment outlined in the reading material known as IVIG. This is very successful but can cause unpleasant side-effects, the most common one being a migraine headache that can last 24 hours. Not all patients can tolerate it. This therapy is usually used in conjunction with LIT. The IVIG product that is used by The Beer Clinic is detergent treated. This product, Venaglobin S, has been in use without incident for over 15 years. There are other products on the market but are not as safe as this one.

At this time the only reliable place to do the entire immunological workup and have the Lymphocyte Immune Therapy and/or IVIG in the US is

Alan Beer Resource Center for Reproductive Immunology & Genetics

15195 National Ave #202
Los Gatos, CA 95032, USA

Phone: (408) 356-9500
(408) 356-9509
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
www.repro-med.net

At the Beer Clinic, you can see either Dr. Trobough or Dr. Stricker. You can send them your blood for testing to see if the LIT or IVIG is necessary. You may not need to physically go there. They will send you a letter outlining your personal protocol (recipe for success) and if you do not require LIT or IVIG you can just have your doctor prescribe the other medications. The Beer Clinic may recommend follow-up blood tests so that they can monitor your progress and adjust your protocol. In Canada, IVIG is available at various centers where a study is being done to determine its effectiveness.

Contact me for further information if you are Canadian.

Recurrent miscarriage

Recurrent miscarriage is a complex and controversial issue but it can be successfully treated step by step. First, if you can get pregnant naturally you are halfway there. If you cannot get pregnant without assisted reproductive technology you must attack your problem on two fronts. You must see the issue as having