An Overview Of Reproductive Immunology
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Contents
Disclaimer
- Indicators for Immune Testing
- Immune Testing
- DQ Alpha
- Leukocyte Antibody Detection
- Reproductive Immunophenotype
- ANA (Antinuclear Antibody)
- Anti-DNA/Histone Antibodies
- APA (Antiphospholipid Antibodies)
- Natural Killer Cell Assay
- Other Tests
Disclaimer 
Please Note: This is a collection of information by reproductive immunology patients. These patients have consulted with doctors all over the United States, read medical papers on the subject and have shared this knowledge with each other through an e-mail group over the past year. The purpose of this information is to inform and empower reproductive immunology patients and not to substitute for the advice of your doctor.
I. Indicators for Immune Testing
The indications are as follows: (a)Two miscarriages or two IVF or GIFT failures after age 35 or three miscarriages or IVF or GIFT failure before age 35, (b)poor egg production from a stimulated cycle (less than 6 eggs), (c)one blighted ovum, (d)idiopathic infertility, (e)previous immune problems (ANA positive, rheumatoid arthritis, and/or lupus), (f)previous pregnancies that have shown retarded fetal growth, and (g)one living child and repeat miscarriages while attempting to have a second child.
II. Immune Testing
A. DQ Alpha
This test measures whether the DNA of the couple is too closely matched. These tests give you back two numbers for both members of the couple. In a normal pregnancy the father's DNA in the baby tells the mother's body to set up a protective reaction around the developing embryo. If the father's DNA is too closely matched to the mother's, there is a good chance that the embryo created by them is unable to differentiate itself from the mother's body. The mother's body then rejects the embryo because it cannot identify the embryo as a baby.
Each person gets two DQ numbers from their respective parents. Similarly, when couples try to have a baby, they also give DQ numbers to their fetus. These numbers are, for example, 1.1, 1.2, 1.3, 1.4, 2, 3 or 4. Although there are breakdowns of the 2's, 3's and 4's, many scientists find that only the 1's are significant, so they break those down to one more decimal. Presently DQ Alpha testing is identifying more and more numbers, for example, DQ 4.0, 4.1, 4.2 and 4.3.
B. Leukocyte Antibody Detection
The immunological chain reaction caused by the DQ Alpha match problems is measured by this test.
C. Reproductive Immunophenotype
This checks for the presence of Natural Killer Cells. In most cases, Natural Killer Cells are good because they keep the body from developing cancer. In this case, however, the body goes overboard and kills the embryo or interferes with your endocrine system that produces hormones essential for pregnancy. These tests measure the following CD (Cell Designation) levels: CD-3 (normal 63-86) CD-4 (normal 31-53) CD-8 (normal 17-35) CD-19 (normal 3-8) C56 (normal 3-12) these are the Natural Killer Cells CD3/IL2-R (normal 0-5) CD19/CD5 (normal 0-10), high numbers in this category interfere with the reproductive hormones necessary for pregnancy.
D. ANA (Antinuclear Antibody)
This test checks for problems similar to lupus and rheumatoid arthritis or other similar immunological diseases that can also result in pregnancy losses or infertility. This test becomes weakly positive in women with infertility and in women with recurrent pregnancy losses. It is usually reported as ANA positive with at titer 1:40 or higher with a speckled pattern. This pattern is not typical of lupus or rheumatoid arthritis or other immunological disorders.
E. Anti-DNA/Histone Antibodies
If a woman reacts to the broken down DNA (histones) and it is a speckled pattern, then she is showing a reaction to her own embryos.
F. APA (Antiphospholipid Antibodies)
When this test is positive, the woman's blood clots too fast cutting off support to the baby. These antibodies also cause the embryo to attach too weakly to the uterus.
G. Natural Killer Cell Assay
This test determines the killing power of a woman's Natural Killer Cells in the test tube. 12% of women with recurrent pregnancy losses and 25% of women with three or more IVF failures have elevations in NK cells and these cells demonstrate aggressive killing of targets and placental cells when tested in vitro. The Natural Killer cells are cultured with varying numbers of target cells that they can kill. This is called the Effector/Target Cell ratio and is given a number of 50:1, 25:1 and 12:1. In a separate panel of cultures IgG is added at 6.25 mg/ml (corresponding to an in vivo administered dosage of 25 grams once) or 12.5 mg/ml (corresponding to an in vivo administered dosage of 25 grams of IVIg for 3 consecutive days). The percentages of the target cells killed are calculated for both panels of cells, those with and those without IVIg.
H. Other Tests
It is important that the woman have other tests that are widely available in all laboratories. These are the Lupus Anticoagulant Antibody, Hormone Antibody Assay, APTT (a blood clotting test) and an antithyroid antibodies.
Alan E. Beer Center for Reproductive Immunology & Genetics
15151 National Ave. #2; Los Gatos, CA 95032; Phone: (408) 356-9500; Fax: (408) 356-9509; E-mail: info@repro-med.net.
Date: 8-28-08, Time: 3:49 pm.
General Question? E-mail: info@repro-med.net.
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