Claudine,
We were advised by the ARGC to consider their battery of immune tests after a failed ICSI and frozen embryo attempt at the Lister. Since my numerous semen analyses all point to poor motility and morphology being the cause of our problems, and statistically two failed attempts is not at all unlikely, we wondered whether immunology was really an appropriate explanation. Scientists presented with rival theories often apply the well-tested principle of "Occam's Razor" - if there's a simple, obvious explanation, it's the right one!
We decided not to go ahead with any tests, partly because we felt there was no compelling reason to think we needed to, but also because we were unconvinced by the treatment protocols offered for "immunological problems". I guess in fairness I should say that in our case there was a little more justification for the tests in so far that the Lister had routinely (!) run their NK test (http://www.miscarriageclinic.co.uk/nk_paper_lock.pdf) and detected a raised level. On the basis of that test, Mo took prednisolone for those two cycles. It's a global immune-suppressing steroid - something that is normally avoided during pregnancy. For this cycle we're going to try without it.
There's an open and fierce scientific debate over the role of immunology in fertility. There's a wealth of information freely available from the internet; many fertility clinics have a couple of pages advocating the immunological treatments they offer, the abstracts to most journals are searchable online and I've downloaded research papers from quite a few too.
I'd be very wary about all this information - a little knowledge is a dangerous thing. I was an academic scientist for 10 years and I know that in my field (physics) to be able to read research papers critically and judge them takes many years of experience. Many professional scientists never understand their own field properly and just muddle by - you would be surprised by the number of papers I've seen presented for publication that are fundamentally flawed. I don't think this is the picture most people have of science - take everything you read with a good pinch of salt. Not surprisingly, and with the greatest respect to them, lay-people that read popular science books and a few research papers truly don't understand what's going on. I've no reason to think that immunology is any different.
My personal feeling is that the importance of immunology is overplayed, that the tests that are suggested are largely pointless and the treatments that are advocated are potentially dangerous and most likely are unhelpful. There's an interesting paper posted on this site at:
http://www.fertilityfriends.co.uk/content/view/261/1/ by Ashley Moffett. She argues that the link between peripheral NK activation and the (dis)function of uterine NK cells is spurious. She makes a point maybe of some relevence to your own situation : "the percentage of CD56+ NK cells in peripheral blood in normal healthy individuals varies from 5% to 29%. Despite this, a finding of more than 12% NK cells in women with infertility or miscarriage has been arbitrarily defined as abnormally raised and used as an indication for treatment". I'm inclined to believe the substance of this paper; there's a report published by the Royal College of Obstetricians and Gynaecologists with similar conclusions.
Does anyone think the following paragraph is an allusion to the much-mentioned Dr Beer? "The situation is reminiscent of the publicity and controversy surrounding paternal leucocyte immunisation as a treatment for recurrent miscarriage in the 1980s. After much flurry and expense, this treatment has now been banned by the US Food and Drug Administration." There's another reference at "Nora"'s site:
http://www.multiplemiscarriage.com/othersTreatment.php which seems to be making a point about this too : "A pioneer in the field of reproductive immunology popularized Paternal Lymphocyte Infusion". Although "Nora" have a vested interest in rubbishing other treatments, they make some interesting points including some strong remarks about IVIG e.g. "it is impossible for IVIG to act directly on uterine NK cells, rendering IVIG unlikely to be effective for pregnancy related disorders."
I do believe that at least the doctors we have spoken to are quite genuine in their wish to help and are not simply after money. However, I do have an uncomfortable feeling that there's a link between the huge amount of money made from these treatments and the frequency with which they're advocated on what I believe to be very flimsy evidence. There is an almost evolutionary principle at work that ensures that the clinics that offer the expensive treatments, even if their effectiveness is somewhat dubious, will be the ones that make money and prosper.
Anyway, the best of luck whatever avenue you decide to take.
Rob (DP of Mo)
![:-\](https://www.fertilityfriends.co.uk/s3/fertilityfriends.co.uk/data/static/Smiley/undecided.gif "Undecided :-\")
