In last month’s post, we started to explore the ongoing debate regarding the role of the immune system in repeated IVF failures. Unfortunately, many patients turn to the internet for answers, leading them to pursue various tests and treatments that often lack scientific backing. Some of these options have proven to offer no real benefit, yet hope drives patients to seek them out. It’s crucial to recognize that healthcare providers have a limited array of validated tests available for these situations. As our understanding of embryo development and implantation evolves, we may discover additional reliable tests down the line. Most tests typically included in an “immunology” assessment are outlined in a table we shared previously. It’s essential to remember that many of these tests, which aim to identify immune deficiencies related to fertility issues, are primarily designed for recurrent pregnancy loss (RPL)—defined as three or more consecutive losses before the 20-week mark.
Controversial Tests and Treatments
Here’s a breakdown of some controversial tests and treatments that are being offered at great expense to patients. These tests are contentious, not just due to their questionable predictive capabilities but also because lab results can vary significantly from one facility to another. Various studies and positions from medical associations have discouraged most reproductive endocrinologists from considering these treatments.
Antiphospholipid Antibodies (APAs)
There’s a link between APAs, particularly anticardiolipin antibodies and lupus anticoagulant, and recurrent pregnancy loss. While some studies have shown a higher prevalence of these antibodies in infertile women, the critical question remains whether they cause infertility or are merely present due to other infertility-related issues. The American Society for Reproductive Medicine (ASRM) has stated that the presence of APA does not affect IVF success.
Anti-sperm antibodies
The scientific community is divided on whether these antibodies hinder fertility. Thankfully, there are effective treatments available for male factor infertility, including intrauterine insemination, IVF, and intracytoplasmic sperm injection.
Anti-thyroid antibodies
Current research does not support routine testing for these antibodies in women undergoing assisted reproduction, as their prevalence is similar in both fertile women and those with unexplained infertility.
Other autoantibodies
Testing for anti-nuclear and anti-smooth muscle antibodies does not show compelling evidence of relevance in diagnosing or treating unexplained infertility.
Leukocyte testing for NK Cells
Immunophenotyping lacks robust scientific support for diagnosing unexplained infertility or IVF failure. Treatments aimed at correcting presumed leukocyte dysfunction have not shown efficacy in treating infertility or RPL. Essentially, using leukocyte tests in fertility practice is not backed by current data.
Questionable Treatments
Treatments following these “immunology tests” also lack proven benefits and may even pose risks.
Lymphocyte immune therapy (LIT)
This controversial approach claims to enhance a woman’s immune tolerance towards her fetus. However, it’s not only pricey but also carries serious risks, such as transfusion reactions and infections. The FDA has imposed restrictions on this treatment.
Intravenous immune globulin (IVIG)
Some studies have suggested improved implantation rates with IVIG, but these findings are inconclusive. A later randomized study indicated that IVIG provided no advantage for recurrent IVF failures.
Steroids
While steroids have immunosuppressive effects, their routine use has been linked to significant risks for both mother and child. Studies have shown no benefits in using steroids during IVF, nor for women with RPL.
Aspirin
The use of aspirin in treating infertility is still up for debate. While some studies show no improvement in pregnancy rates, others suggest it may enhance outcomes for specific women, especially those with blood clotting disorders.
Heparin
The effectiveness of heparin in facilitating implantation is hotly debated. Some studies indicate benefits, particularly in women with antiphospholipid antibody syndrome, while others have found no advantages.
In Summary
Women facing the heartbreak of unexplained IVF failures often feel pressured to pursue treatments that are not widely accepted in the medical community. Some non-specialist practitioners advocate for unproven tests and treatments, which are largely dismissed by the majority of reproductive endocrinologists. Current FDA guidelines suggest that treatments like IVIG and LIT should only be considered in the context of carefully monitored clinical trials. We do not recommend these approaches, even when options seem limited.
For further reading, you might find this excellent resource on intrauterine insemination helpful, as well as our post on exploring fertility treatment options for more insights. If you’re considering at-home insemination, check out this kit for comprehensive options.