Testing for Recurrent Pregnancy Loss
A starting list of tests for your doctor to run if you are experiencing recurrent pregnancy loss (RPL). This post is simply a starting point to help you start the conversation, though your care should be guided by your doctor.
Anti Phospholipid Antibodies (APA)- cardiolipins are proteins found in your body that work against your body. Cardiolipins help regulate blood flow throughout the body. However, when your body looks at the cardiolipins as an invader, it will attack them. The three main groups are: IgG, IgM, IgA.
- Normal Results: IgG is below 23 ug/mL, while normal IgM and IgA is below 11 ug/mL. This indicates typical levels of cardiolipin antibodies in your blood.
- Abnormal Results: levels between 25ug/mL and 70 ug/mL. However, these levels may interfere with your ability to become pregnant or carry a pregnancy to term.
Other anticoagulant tests that fall under APA are the following:
Anti Cardiolipin Antibodies (ACA)- cells that attack the nuclei of other cells in your body. This is a mistake made by the body, thinking the good guys are the bad guys. Low levels should cause no problems.
- Normal results: levels are typically under 1:20, though 1:40 is also acceptable.
- Abnormal Results: levels above 1:40 indicate a high presence of anti nuclear antibodies in your blood.
Anti Nuclear Antibodies (ANA)- Again this is your body mistaking the good for the bad. Only this time it attacks the nuclei of the cell(s).
- Normal and abnormal levels are the same here as they were for the APA.
- Typical treatment for abnormal results is the use of the medication prednisone.
Lupus Anti Coagluant (LAC)- this is a protein in your blood that causes it to clot in your bloodstream and veins differently than it normally would. To test for this there are actually several tests compiled and then looked at as a whole. These tests are the Activated Partial Thromboplastin Time (aPTT), the Modified Russel Viper Venom Time (VPTT), the Platelet Neutralization Procedure (PNP), and the Kaolin Clotting Time (KCT).
The typical treatment for this is baby aspirin, prednisone, and heparin/lovenox.
Anti Thyroglobulin Antibodies (ATA)- Thyroglobulin is the protein that connects with the thyroid, which produces different types of hormones. Antithyroglobulin is usually found with antimicrosomal antibody in the bloodstream. These two antibodies together, a.k.a antithyroid antibodies, attack the thyroid gland.
- Normal/ Negative Results: levels less than 1:72
- Borderline Results: levels between 1:72 and 1:300.
- Abnormal/ Positive Results: levels higher than 1:300
Further testing is usually required to rule out other issues and is then treated with prednisone and dexamethasone.
Parental Chromosome/ Karyotype- when blood samples are taken from both partners and tested for extra chromosomes, missing chromosomes, deletions or additions to the data within each chromosome, and translocations of chromosomes (in which all chromosomes are present but rearranged.
Embryo Toxic Factory (ETF) Panel- this when your immune system looks at your new embryo and says, “invader!” So it attacks the embryo because your body is producing too many white blood cells. This test occurs in two steps
First, your blood is taken and the cells (lymphocytes) are isolated and placed ina special solution
Second, is the embryo culture. This is when the lyphocytes are combined with a two-cell embryo from a mouse. After several days, the mouse embryos are looked at again to see if toxic substance is being produced. If the mouse embryo has stopped developing or died, it is and indication of ETF. If it’s still developing then there is no toxic substance being produced.
Anti-Mullerian Hormone (AMH)- this appears to a relatively new test. However, it is expensive and still not covered by insurance companies. It is projected that it is accurate 70% of the time.
This test measures the hormone, Anti-Mullerian, which is produced by the ovaries. This hormone does not fluctuate through out the month and is considered to be an indicator of a women’s ovarian function. The manufacture believes this test to be a more reliable test than testing a women’s oestrogen. If it turns out that this is true it could be a predictor in how successful a women will be when undergoing IVF and a diagnostic test to help indicate if a women has PCOS. Women with PCOS have higher levels of AMH than their peers.
NK Cell Test/ Natural Killer Cell Activity Levels- this test measures the bodies immune system and it’s natural production of natural killer cells. Natural killer cells are made by the body to attack cancer cells. Once the NK cell binds with the cancer cell it emits a toxic chemical to kill the cell. However, during pregnancy the natural killer cell mistakes the embryo for a cancer cell and begins attacking. This is why women with multiple miscarriages, or Recurrent Pregnancy Loss, have a tendency to have high levels of NK Cells.
In the lab after mixing the NK cells and embryonic cancer cells and dying ech with a different solution they are cultured. After two hours, another solution is added that absorbs only the dead cells. Finally, the remaining cells are placed under a laser and counted by a computer. The number of cells left indicate a positive or negative result.
The treatment for a positive NK is IVIg. This is where blood products are gathered and used in an infusion. This infusion helps suppress the immune system and success rates are as high as 80%. Treatment lengths vary and can start as early as 2-3 weeks before conception and as late as 35 weeks. Also, an individual treatment of IVIg can cost anywhere from $3,000- $5,000.
However, it should be noted that many in the field of reproductive medicine consider this treatment and test controversial as there has been difficulty duplicating studies. If you are interested though, to get started you can check out SIRM (Sher Institute of Reproductive Medicine) at haveababy.com. There are several clinics throughout the country and if travel is not an option for you perhaps you can look at their chat rooms/ message boards and get some ideas of where to begin in your area.
Leukocyte Antibodies Detection (LAD)- Leukocytes are white blood cells. During a pregnancy your body can recognize your baby as an invader and attack it. In response to this your body produces leukocyte antibodies. These antibodies are found in pregnant women, those receiving blood transfusions, and donated organs.
- Lower- than normal levels of these antibodies have been liked to those with miscarriage, still births, and recurrent pregnancy loss.
- Normal Levels/ Negative Results: above 50%
- Borderline Level Results: between 30% and 50%
- Abnormal Levels/ Positive Results: less than 30%
Treatment is Leukocyte Immunization Therapy (LIT) and consists of an injection of white blood cells either given by your partner or donated.
**** It is important that you have the traditional IF work up done in conjunction with these tests as well if you are suffering from Recurrent Pregnancy Loss*****