Reproductive immunology

Reproductive immunology refers to the phenomenon of immunological arrest that allows a mother to accept a foreign embryo. The treatment of immune problems addresses infertility, recurrent miscarriages, premature deliveries, and dangerous complications of pregnancy, such as pre-eclampsia. There are five categories of immune problems that can cause infertility, IVF failure and pregnancy loss, with category 1 being the least severe and category 5 the most severe. A woman with category 1 problems who experiences recurrent pregnancy loss may activate immune problems from any of the other categories.

Category 1: HLA (human leukocyte antigen) compatibility — the couple’s tissues are too similar genetically.
Category 2: Problems with blood clotting. Phospholipid adhesion molecules create an autoantibody response.
Category 3: An autoimmune response occurs to components in the embryo.
Category 4: Autoimmune response to sperm antigen.
Category 5: Certain types of immune cells increase in number and activity, including natural killer (NK) cells, antibodies to hormones, and antibodies to neurotransmitters.

Chinese medicine treatment of immunological factors

Chinese medicine provides effective treatment for reproductive immunology by treating the root cause of immune system imbalance:

Acupuncture has a profound homeostatic effect on the immune system, bringing it back into balance, whether it is hyper- or hypo-functioning. Stress reduction acupuncture is also often needed when immune factors are present.

Herbal medications can be used to enhance the functioning of drug protocols and minimize their side effects.

Reproductive organ massage is useful in cases where there is reduced blood flow to the reproductive system.

Nutrition and dietary therapy provide important cofactors that reduce blood clotting and calm the immune system.

Factors that indicate for the need for immune testing:

  • Two miscarriages, IVF or GIFT failures after age 35, or three miscarriages, IVF or GIFT failures before age 35
  • Poor number of eggs produced from a stimulated cycle (less than 6 eggs)
  • Blighted ovum
  • Idiopathic infertility (unexplained)
  • History of autoimmune disorders (ANA positive, rheumatoid arthritis, and/or lupus)
  • History of pregnancy with retarded fetal growth
  • Secondary infertility

Testing used in reproductive immunology:

  • DQ alpha testing measures whether the DNA of the couple is too closely matched
  • Leukocyte antibody detection is a more expansive test of DQ alpha
  • Reproductive immunophenotyping checks for the presence of natural killer (NK) cells
  • Cell designation tests: CD-3, CD-4, CD-8, CD-19, CD-56, CD3/IL2-r, and CD19/CD5
  • ANA (antinuclear antibody) testing checks for antibodies similar to lupus and rheumatoid arthritis
  • Anti-DNA/histone antibody tests
  • APA (antiphospholipid antibodies) and APTT (activated partial thromboplastin time) both test for clotting factors
  • Natural killer cell assay determines the strength of the NK cells
  • TJ6 protein is produced by cells in the lining of the uterus; the TJ6 protein has the function of controlling NK cells
  • Lupus anticoagulant antibody assay
  • Hormone antibody assay
  • Antithyroid antibody tests

Western treatment of immunological factors

Western treatment uses medication to help prevent miscarriage associated with immune system problems:

Prednisone is a corticosteroid and anti-inflammatory that is normally taken prior to conception and is used to treat women who have antinuclear antibodies.

Immunoglobulin G infusion (IVIG) is a preparation of human antibodies injected intravenously. It is used to treat women who have elevated levels of NK (natural killer) cells or antithyroid antibodies.

Enbrel, also known as etanercept, is a medication that binds directly to tumor necrosis factor and inhibits its attachment to the placental membrane.

Heparin is an anti-coagulant used to prevent miscarriage due to anti-phospholipid antbodies.

Low-dose aspirin is an anti-inflammatory used to suppress the innate immune response to the presence of a foreign body such as sperm or an embryo. It is also an anti-platelet agent useful for anti-phospholipid antibodies.

Lymphocyte immunization therapy (LIT) is a medical procedure not currently performed in the USA. It is typically used to reduce NK (natural killer) cells.