Introduction
Recurrent miscarriage (RM) is usually defined in North America, Russia, and Western Europe as two or more miscarriages before 20 weeks of gestation but in the UK as three or more consecutive miscarriages. All treatment modalities used for RM depend on immunomodulation for their effects. Aspirin is used for its anti-inflammatory effects, anticoagulants for their anti-inflammatory and anticoagulant effects, and steroids for their anti-inflammatory effects. This article describes active immunization with paternal leukocytes, passive immunization using intravenous immunoglobulin (IVIg), intralipid, and the use of growth factors such as G-CSF (filgrastim) to enhance placental and fetal growth and increase subsequent live births.
The problem is that all methods of immunotherapy have been assessed by an evidence-based approach in comparative trials, either randomized or blinded, or both, and compared to no treatment. Using this approach, it soon became clear that immunotherapy is not a panacea for treating all patients with RM. Unfortunately, there are no definite laboratory criteria by which immune-mediated mechanisms can be positively identified. Attempts have been made to use antipaternal complement-fixing antibodies and the number and killing activity of natural killer (NK) cells as selection criteria, but neither is sufficiently specific. Additionally, the effect of confounding factors such as embryonic structural malformations and embryonic genetic aberrations has not usually been taken into account.
This chapter discusses the efficacy, mode of action, and side effects associated with immunopotentiation in recurrent pregnancy loss.