For those women who aren’t conceiving or who have miscarried over and over and over again the title says it all and we are left asking ourselves: “Is My Body At War With Itself?” It’s often difficult to figure out what would be happening for us to fail at something we so desperately want.
Regarding fertility as a whole we know for instance that when two healthy individuals attempt to conceive each month even when all of the conditions are perfect it’s a one in four chance of conception – or 25% chance each month. To make the stats even more frustrating — out of that 25% who do conceive one in four or 25% of those pregnancies end up in miscarriage for a myriad of reasons.
What causes us not to conceive?
Lots of things:
Age, illness, disease, structural issues, male factor issues, egg quantity and quality, lack of eggs, premature ovarian failure, and hormone imbalances as well endocrine problems can create challenges in trying to get pregnant. However, one of the biggest causes that goes undiagnosed are immune issues.
or auto immune disorders are probably one of the hardest issues to properly diagnose because they can remain hidden. Many women who are trying to get pregnant and have immune issues have a difficult time getting correct diagnosis. In some cases, women are mistakenly diagnosed with other conditions. Sometimes doctors tell patients that their symptoms, which are often vague in the case of an autoimmune disorder, are just in their heads or are stress-related – that personally drives me crazy! A quest to find a doctor who can arrive at a proper diagnosis can be difficult and often time consuming and expensive.
But let’s back up a bit regarding immune disorders. The jury’s still sort of out amongst physicians regarding immune disorders, and let me be clear because I am not doctor so I am not here to tell you that immune issues are the reason we don’t get pregnant. But I am here to tell you that immune issues could be a reason for infertility losses and failures. That’s why it’s so important to learn about immune issues, their causes, testing and treatment.
If you’re like me and have an ongoing affair with Dr. Google you might find yourself researching immune disorders and infertility. During your search will probably find many websites and forums that will tell you that immune problems can cause you not to get pregnant for IVF and you “should be tested”.
The American Society of Reproductive Medicine published a committee report many years ago (1999)
“Antiphospholipid antibodies do not affect IVF Success”. The following is a direct quote:
“Controversy exists regarding a possible association between immune abnormalities and in vitro fertilization failure. The proposed mechanism of such failure includes abnormal implantation, placentation, and early embryonic vascular compromise. Intravenous immunoglobulin (IVIG) and antithrombogenic therapy including aspirin and heparin have been proposed as treatments in the expectation of improving implantation or placentation.”
There were two separate articles in the October 2000 issue of Fertility and Sterility appeared supporting this view. The first was written by Dr Hornstein at Harvard: “Antiphospholipid antibodies in patients undergoing IVF: the data do not support testing”. The second was with Dr Hill from the same institution who wrote: “there is no proof that antiphospholipid antibodies cause infertility.”
However, this was back in 2000, and I think things have changed for the past thirteen or so years.
And even though there was and still is a disagreement about the whole immune issue thing we do know that in some cases antiphospholipid antibodies and lupus anticoagulant can cause miscarriages. However, (this is where the jury is still out) most will say this isn’t the reason for infertility. And this is where the majority of patients say “It’s my right to have immune testing, so why not?”
Most physicians will tell a patient that they don’t do any sort of immune testing until they have experienced at least three miscarriages. Most feel that some sort of investigation is warranted if 3 or more miscarriages have occurred. Most clinics do not usually investigate for less than 3 because miscarriages are very common and usually due to chromosomal errors.
In my book that’s ridiculous. Why in the world would a woman who’s trying to have a baby need to experience two losses before basic immune testing is performed? The tests are simple, it’s just a series of blood tests. Some insurance companies will pay for these tests and others will not. Can they be expensive? Sure – but really in the grand scheme of things when we are trying to have a baby and are resorting to Advanced Reproductive Technology regardless of whether we are seeking treatment in the USA, or abroad (Spain, Israel, India, the UK, The Czech Republic, The Ukraine, Australia etc…) I think immune testing should be part of the whole infertility work-up BEFORE any sort of fertility treatment is started and I think immune testing should be GLOBAL, in all countries.
In our next part of this three part series we will talk about what a basic immune panel looks like, what tests are involved, and how you can best advocate for yourself in regards to testing.