Immune testing in fertility practice: truth or deception?
OBJECTIVE
Much attention has been paid to the role of immunology in reproductive success or failure. Every step in the establishment of normal pregnancy has been implicated as a possible site of immune-mediated reproductive failure. The widespread testing of antiphospholipid, antinuclear, antithyroid, and antisperm antibodies, as well as generalized immune testing, have thus been employed to diagnose patients with otherwise unexplained infertility or recurrent pregnancy loss. Controversial data surrounding the widespread and variable use of immune testing in current fertility practice is reviewed to determine which tests are warranted based on sound scientific evidence. Because it is postulated that early miscarriage, when occult, could represent a failure of embryo implantation indistinguishable from unexplained infertility, this analysis of immune testing includes a discussion of patients with recurrent pregnancy loss.


RESULTS
Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect between these phenomena. There is wide variation and inconsistency regarding this association, depending upon which test(s) are employed, the study methodology used, and the patient population under study. The significance of selected immunological test abnormalities associated with early reproductive failure is uncertain.


CONCLUSIONS
Great variability exists in identifying candidates for immune testing, determining which tests to order, interpreting the test results, and offering immunologic treatments. This review argues that the use of widespread immune testing in clinical practice can not be supported by existing data. The resulting therapies are similarly of unconfirmed benefit and may cause harm.
Kallen
Caleb B
CB
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Arici
Aydin
A
D017152:Antibodies, Antiphospholipid; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007159:Immunologic Tests / Q000941:ethics; D007247:Infertility, Female / Q000276:immunology*; D011247:Pregnancy; D012098:Reproduction / Q000276:immunology*; D012099:Reproductive Techniques / Q000941:ethics; D017211:Treatment Failure; D014481:United States
D017152:Antibodies, Antiphospholipid