A woman’s ability to successfully maintain a pregnancy is significantly influenced by a complex alteration of her immune system designed to prepare her body to host a developing embryo.
There are other immunological alterations that occur to protect the developing embryo, which is essentially a foreign organism developing within a woman’s body. In some cases these mechanisms do not work as intended and, depending upon the circumstances, might cause immune system disorders that result in recurrent miscarriages, infertility, or failure to conceive following IVF.
When should immunological testing be considered?
- 2 or more miscarriages after the age of 35 OR 3 miscarriages before the age of 35
- 2 IVF failures after the age of 35 OR 1 failed IVF before the age of 35
- Poor egg production from a stimulated cycle (6 eggs or less)
- Pre-existing immune problems (Lupus, Rheumatoid Arthritis, MS)
- 1 healthy pregnancy with all subsequent pregnancies ending in miscarriage
- Endometriosis, especially stage 1 & 2
- Cold and flu-like symptoms, sore throat noted regularly after ovulation, IUI, or IVF transfer
- Family history of immune disorders, either side of the family
Testing of the immune system is often undertaken for:
- Recurrent miscarriage
- Repeated failure of IVF
- Unexplained difficulties trying to achieve a pregnancy
- History of immune disorders
- History of thyroid disease.
- Previous pregnancies where there have been placenta related complications such as pre-eclampsia, premature delivery or fetal growth restriction
Laboratory Tests
Antiphospholipid antibodies (APA)
- Anti-phosphatidylserine Antibodies (IgG & IgM)
- Anti-phosphatidic Acid Antibodies (IgG & IgM)
- Anti-phosphatidylglycerol Antibodies (IgG & IgM)
- Anti-phosphatidylinositol Antibodies (IgG, IgM)
- Anti-phosphatidylethanolamine Antibodies (IgG, IgM)
- Anti-phosphatidylcholine Antibodies (IgG, IgM)
- Anti-prothombin Antibodies (IgG, IgM)
- Anti-annexin Antibodies (IgG, IgM)
- Anti- β2 glucoprotein Antibodies (IgG, IgM)
- Anti-cardiolipin Antibodies (IgG, IgM)
Antinuclear Antibodies (ANA)
- Anti-Histone antibodies
- Anti-dsDNA antibodies
- Anti-Jo-1 antibodies
- Anti-La (SS-B) antibodies
- Anti-Ro(SS-A) antibodies
- Anti-Scl-70 antibodies
- Anti-Sm antibodies
- Anti-Sm/RNP antibodies
Antithyroid antibodies panel
- Anti-microsomal antibody
- Anti-thyroglobulin antibody
Antipaternal Leukocyte Antibodies Panel
Non-complement fixing maternal antipaternal leukocyte antibodies (blocking antibodies or allo-antibodies) and antipaternal cytotoxicity antibody (APCA) (flow cytometric assay)
Immunophenotype
Extensive white blood cell differential, including,
T-cells (CD3), B-cells (CD19), T helper cells (CD4), T suppressor cells (CD8), activated T cells (DR), natural killer cells (CD56/CD16), and cytotoxic B cells (CD5/CD19). (flow cytometric assay), NK cells CD57+
Natural Killer Cell Activation Assay
The percentage of NK cells displaying the activation marker CD69. (flow cytometric assay)
Natural Killer Cell with IVIg Assay
12 parameters
A functional assay that assesses killing power of NK cells and ability of IVIg to inhibit this activity in-vitro (flow cytometric assay)
Th1/ Th2 assay
The test stimulating the cytokines that indicate whether they are Th1 type cells or Th2 type cells.
T regulatory cells
T regulatory cells are a crucial marker in reproductive immunology. The T regulatory assay to be particularly useful in patients who have suffered chromosomally normal losses and even have normal NK and TH1/TH2 results.
Human Leukocyte Antigens
(HLA) ABC and (HLA) DR/DQ
Class I and II Major Hisotocompatability Antigens (tissue type). (PCR technology)
DQα/DQβ Genotyping
HLA DQα/DQβ Alleles genotyping (PCR technology)
Thrombophilia panel: (Total 8 genetic Loci)
- Prothrombin
- Antithrombin
- Factor V Leiden. Factor V
- Factor XIII
- MTHFR
- Plasminogen Activator Inhibitor – 1 (PAI-1).
- Human platelet antigens (HPA1)
- APO-E gene Protein C
- Protein S Homocysteine
