Every day, our immune system is in a delicate balance between attack and calm. Always poised and ready to attack an invading organism, but not so active that it damages our own bodies. However, in women with immune-mediated infertility, their immune system is not properly balanced and can not be down-regulated in the presence of an embryo. The goal of a reproductive immunologist is to push the immune system slightly in the direction of an embryo-accepting immune system without over-suppressing the immune system. This must be done BEFORE fertilization occurs and during pregnancy. A very good and detailed reproductive immunologist will order numerous tests to predict how the patient’s immune system will respond to an embryo and to various treatments. Once this knowledge is obtained, a detailed treatment plan will be created and may include a number of medications such as Prednisone, IVIG, Neupogen, Humira, as examples. Many times, a combination of these medications is necessary to address different aspects of our very complex immune system. Some medications work better than others for different situations or a proper combination of more than one medication may be necessary.
Today’s blog is about Intravenous Immunoglobulin (IVIG). IVIG can be an important part of a successful infertility treatment protocol. IVIG is an immune modulating treatment that tips the mother’s immune system in favor of the embryo. IVIG can non-specifically shield the embryo from the mother’s immune system, it can suppress immune reactions against the embryo, it can decrease the production of antibodies that may cause immune destruction of the embryo, it can increase proper placenta formation by increasing growth factors such as G-CSF, and it can increase the number and activity of T regulatory cells that can suppress immune attack of the embryo. When properly administered, IVIG can help a mother’s dreams come true.
IVIG is not a one size fits all medication. There have been some studies that do not show an advantage to using IVIG over a placebo control. Most of these studies are done on a randomly selected population of women who either have implantation failure or multiple miscarriages. Testing has not been done on these women to show that they need immune treatments to have a baby. The research subjects are then given a standard dose of IVIG or a placebo control either before ovulation or upon a positive pregnancy test. Often the dose of IVIG that is prescribed is low and is not even equivalent to the dosing that is used in other instances where the immune system needs to be calmed, such as in autoimmune disease. The randomly selected research subjects are given IVIG at equally spaced times during pregnancy. NO testing is done prior to or during pregnancy to see how much IVIG is needed (if it is needed at all) and how often the IVIG must be administered before ovulation and during pregnancy. Since proper testing and treatment is not done, the results are often inconclusive. In order for immune treatments to work, a treatment protocol must be individually tailored to each patient’s immune system. If testing is done both before and during pregnancy to determine the appropriate immune modulating treatment protocol, a healthy pregnancy will more than likely be achieved. IVIG played an important role in both of my pregnancies and I have 2 healthy children because of it!