Immunological testing and treatment in reproduction: frequency assessment of practice patterns at assisted reproduction clinics in the USA and Australia.
BACKGROUND
The roles that alloimmunity and autoimmunity may play in reproductive failure, including recurrent pregnancy loss and failed IVF, have not been clearly established. To help define practice patterns, we investigated what tests clinicians in the USA and Australia were offering, to which patients (diagnostic groups) the tests were recommended, and in what situations immunological/anticoagulation treatment was advised.


METHODS
A five section survey was completed by senior physicians attending the annual national fertility society meetings in the USA and Australia. Results were tabulated and analysed.


RESULTS
Antiphospholipid antibody testing was offered to patients with recurrent pregnancy loss by almost all physicians surveyed. Patients with previous failure of IVF were tested much less often. Other immune tests (embryotoxic assay, natural killer cells and leukocyte antibodies) were ordered by none of the Australian participants and approximately 25% of the American participants. The use of immunotherapy and anticoagulation therapy for patients who tested positive for various immunological tests was also evaluated for frequency of use and reported secondary complications.


CONCLUSIONS
Large, well-structured studies examining the benefits of immunological evaluation and treatment are necessary before definite recommendations can be made.
Ghazeeri
G S
GS
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Memphis, TN 38163-2116, USA.
Kutteh
W H
WH
D000026:Abortion, Habitual / Q000276:immunology; D017152:Antibodies, Antiphospholipid / Q000032:analysis; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001315:Australia; D003625:Data Collection; D004704:Endocrinology / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D007159:Immunologic Tests; D007167:Immunotherapy; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012099:Reproductive Techniques; D017211:Treatment Failure; D014481:United States
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D016756:Immunoglobulins, Intravenous