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*
| Test |
Purpose |
| Laboratory Tests |
| 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 |
| Procedures |
hysterosalpingogram
or hysteroscopy |
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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