Abstract
Intravenous immunoglobulin (IVIg) has been used to prevent pregnancy loss, in unexplained recurrent miscarriage, and in antiphospholipid syndrome (APS). When used on an unselected population with recurrent miscarriage, IVIg has not been shown to improve the live birth rate. However, when patients are selected for poor prognosis or autoimmune phenomena, IVIg has been shown to be effective. This article discusses the possible immune mechanisms by which IVIg may act and the effect of confounding factors such as embryonic chromosomal aberrations or anti-β2-glycoprotein I antibodies in APS. Hence, there may be an impression of futility, when IVIg may be highly effective in saving those pregnancies that can be saved. Additionally, in an unselected population with recurrent miscarriage, there is a relatively good prognosis for a subsequent live birth (60%). Therefore, the spontaneous prognosis must be taken into account, which has not been the case in previous trials.
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Scott, J. R. (2003), Cochrane Database Syst Rev 1, CD000112.
Sullivan, A. E., Silver, R. M., LaCoursiere, Y., Flint Porter, T., and Ware Branch, D. (2004), Obstet Gynecol 104, 784–788.
Stern, J. J., Dorfman, A. D., Gutierez-Naja,r M. D. (1996), Fertil Steril 65, 250–263.
Takakuwa, K., Asano, K., Arakawa, M., Yasuda, M., Hasegawa, I., and Tanaka, K. (1997), Fertil Steril 68, 54–58.
Ogasawara, M., Aoki, K., Okada, S., and Suzumori K. (2000), Fertil Steril 73, 300–304.
Philipp, T., Philipp, K., Reiner, A., Beer, F., and Kalousek, D.K. (2003), Hum Reprod 18, 1724–1732.
Carp, H. J. A. (2000) In: Ratnam, S.S., Ng, S. C., and Arulkumaran, S. eds. Contributions to Obstetrics & Gynaecology. Singapore:Oxford University Press, pp. 75–107.
Morton, N. E., Chiu, D., Holland, C., Jacobs, P. A., and Pettay, D. (1987), Am J Med Genet 28, 353–360.
Warburton, D., Kline, J., Stein, Z., Hutzler, M., Chin, A., and Hassold T. (1987), Am J Hum Genet 41, 465–483.
Rai, R. S., Clifford, K., Cohen, H., and Regan, L. (1995), Hum Reprod 10, 3301–3304.
Empson, M., Lassere, M., Craig, J. C., and Scott, J. R. (2002). Obstet Gynecol 99, 135–144.
Savion, S., Brengauz-Breitmann, M., Torchinsky, A., and Toder, V. (1999), Teratog Carcinog Mutagen 19, 171–182.
Torchinsky, A., Shepshelovich, J., Orenstein, H., et al. (2003), Am J Reprod Immunol 49, 159–168.
King, A., Jokhi, P. P., Burrows, T. D., Gardner, L., Sharkey, A. M., and Loke, Y. W. (1996), Am J Reprod Immunol 35, 258–260.
Levi, M. and Ten Cate, H. (1999), N Engl J Med 341, 586–592.
Yan, S. B., Helterbrand, J., Hartman, D. L., Wright, T. J., and Bernard, G. R. (2001), Chest 120, 915–922.
Beck, T. W., Magnuson, N. S., and Rapp, U. R. (1995), Curr Top Microbiol Immunol 194, 291–303.
Force, T. and Bonventre, J. V. (1998), Hypertension 31, 152–161.
Hammarstrom, L. and Smith, C. I. (1986), Lancet 1, 681.
Sidiropoulos, D., Herrmann, U., Morell, A., von Muralt, G., and Barandun, S. (1986), J Pediatr 109, 505–508.
Cullinan, E. B., Abbondanzo, S. J., Anderson, P. S., Pollard, J. W., Lessey, B. A., and Stewart, C. L. (1996), Proc Natl Acad Sci USA 93, 3115–3120.
Robb, L., Li, R., Hartley, L., Nandurkar, H. H., Koentgen, F., and Begley, C. G. (1998), Nat Med 4, 303–308.
Robertson, S.A., Roberts, C. T., Farr, K. L., Dunn, A. R., and Seamark, R. F. (1999), Biol Reprod 60, 251–261.
Clark, D. E., Smith, S. K., Licence, D., Evans, A. L., and Charnock-Jones, D. S. (1998), J Endocrinol 159, 459–467.
Schäfer-Somi, S. (2003), Anim Reprod Sci. 75, 73–94.
Chaouat, G., Zourbas, S., Ostojic, S., et al. (2002), J Reprod Immunol 53, 241–256.
Abe, Y., Horiuchi, A., Miyake, M., and Kimura, S. (1994), Immunol Rev 139, 5–19.
Ross, C., Svenson, M., Hansen, M. B., Veijlsgaard, G. L., and Bendtzen, K. (1994), J Interferon Res 14, 159–160.
Andersson, J., Skansen-Saphir, U., Sparrelid, E., and Andersson, U. (1996), Clin Exp Immunol 104 Suppl 1, 10–20.
Sherer, Y., Wu, R., Krause, I., et al. (2001), Hum Antibodies 10, 51–53.
Graphou, O., Chioti, A., Pantazi, A., et al. (2003), Am J Reprod Immunol 49, 21–29.
Sharief, M. K., Ingram, D. A., Swash, M., and Thompson, E. J. (1999), Neurology 52, 1833–1838.
King, A. (2000), Hum Reprod Update 6, 28–36.
Guimond, M. J., Wang, B., and Croy, B. A. (1998), J Exp Med 187, 217–223.
King, A. and Loke, Y.W. (1990), Cell Immunol 129, 435–448.
Yui, J., Garcia-Lloret, M., Wegmann, T. G., and Guilbert, L. J. (1994), Placenta 15, 819–835.
Clifford, K., Rai, R., and Regan, L. (1997), Hum Reprod 12, 387–389.
Beer, A. E., Kwak, J. Y., and Ruiz, J. E. (1996), Am J Reprod Immunol 35, 376–382.
Shakhar, K., Ben-Eliyahu, S., Rosen, E., Loewenthal, R., and Carp, H. J. A. (2003), Fertil Steril 80, 368–375.
Emmer, P. M., Nelen, W. L., Steegers, E. A., Hendriks, J. C., Veerhoek, M., and Joosten, I. (2000), Hum Reprod 15, 1163–1169.
Aoki, K., Kajiura, S., Matsumoto, Y., et al. (1995), Lancet 345, 1340–1342.
Coulam, C. B. and Beaman, K. D. (1995), Am J Reprod Immunol 34, 219–224.
Ruiz, J. E., Kwak, J. Y., Baum, L., et al. (1996). J. Reprod Immunol 31, 125–141.
Kwak, J. Y., Kwak, F. M., Ainbinder, S. W., Ruiz, A. M., and Beer, A. E. (1996), Am J Reprod Immunol 35, 363–369.
Szereday, L., Spath, P., and Szekeres-Bartho, J. (1999), Am J Reprod Immunol 42, 282–287.
Knackstedt, M. K., Zenclussen, A. C., Hertwig, K., et al. (2003), Am J Reprod Immunol 49, 210–220.
Bertolaccini, M. L., Atsumi, T., Lanchbury, J. S., et al. (2001), Thromb Haemost 85, 198–203.
Ernofsson, M., Tenno, T., and Siegbahn, A. (1996), Br J Haematol 95, 249–257.
Rand, J. H. (2003), Annu Rev Med 54, 409–424.
Bakimer, R., Guilburd, B., Zurgil, N., and Shoenfeld Y. (1993), Clin Immunol Immunopathol 69, 97–102.
Marzusch, K., Dietl, J., Klein, R., Hornung, D., Neuer, A., and Berg, P. A. (1996). Acta Obstet Gynecol Scand 75, 922–926.
Harris, E. N. and Pierangeli, S. S. (1998), Scand J Rheumatol Suppl 107, 97–102.
Kimberly, R. P., Salmon, J. E., and Bussell, J. B. (1987), J Immunol 132, 745–750.
Brand, A., Witvliet, M., and Class, F. H. J. (1988), Brit J Hematol 69, 507–511.
Shoenfeld, Y., Rauova, L., Gilburd, B., et al. (2002), Int Immunol 14, 1303–1311.
Coggeshall, K.M. (1987), Curr Opin Immunol 10, 306–312.
Terness, P. and Opelz, G. (1998), Int Arch Allergy Immunol 115, 270–277.
Simon, H. U. and Spath, P. J. (2003), Allergy 58 543–552.
Bayry, J., Misra, N., Latry, V., et al. (2003), Transfus Clin Biol 10, 165–169.
Thornton, B. P., Vetvicka, V., and Ross, G. D. (1994), J Immunol 152, 1727–1737.
Caccavo, D., Vaccaro, F., Ferri, G. M., Amoroso, A., and Bonomo, L. (1994), J Autoimmun 7, 537–548.
Galli, M., Cortelazzo, S., and Barbui, T. (1991), Am J Hematol 38, 184–188.
Sherer, Y., Levy, Y., and Shoenfeld, Y. (2000), Rheumatology 39, 421–426.
Kwak, J. Y., Quilty, E. A., Gilman-Sachs, A., Beaman, K. D., and Beer, A. E. (1995), J Reprod Immunol 28, 175–188.
Zenclussen, A. C., Gentile, T., Kortebani, G., Mazzolli, A., and Margni, R. (2001), Am J Reprod Immunol 45, 289–294.
Lubinski, J., Vrdoljak, V. J., Beaman, K. D., Kwak, J. Y., Beer, A. E., and Gilman-Sachs, A. (1993), J Reprod Immunol 24, 81–96.
Ito, K., Tanaka, T., Tsutsumi, N., Obata, F., and Kashiwagi, N. (1999), Hum Reprod 14, 650–655.
Pandey, M. K. and Agrawal, S. (2002), Obstet Gynaecol Today 10, 574–578.
Behar, E., Carp, H. J. A., Livneh, A., and Gazit, E. (1991), Am J Reprod Immunol 26, 143–146.
Maruyama, T., Makino, T., Iwasaki, K., et al. (1994), Am J Reprod Immunol 31, 7–18.
Omwandho, C. O., Gruessner, S. E., Roberts, T. K., and Tinneberg, H. R. (2004), Clin Chem Lab Med 42, 359–370.
Shoenfeld, Y. and Blank, M. (2004), Autoimmun Rev Suppl 1, S32-S34.
Krause, I., Wu, R., Sherer, Y., Patanik, M., Peter, J., and Shoenfeld, Y. (2002), Transfus Med 12, 133–139.
Basta, M. and Dalakas, M. C. (1994), J Clin Invest 94, 1729–1735.
Lutz, H. U., Stammler, P., Spath, P. J., Hess-Schmid, M., Trueb, R. M., and Jelezarova, E. (1998), Mol Immunol 35, 368A.
Salmon, J. E., Girardi, G., and Holers, V. M. (2003), Lupus 12, 535–538.
Walpen, A. J., Laumonier, T., Aebi, C., Mohacsi, P. J., and Rieben, R. (2004), Xenotranspl 11, 141–148.
Preston, F. E., Rosendaal, F. R., Walker, I. D., et al. (1996), Lancet 348, 913–916.
Alfirevic, Z., Roberts, D., and Martlew, V. (2002), Eur J Obstet Gynecol Reprod Biol 101, 6–14.
Scott, J. R. and Pattison, N. (2000), Cochrane Database Syst Rev CD000101.
Carp, H. J. A., Toder, V., Gazit, E., Ahiron, R., Mashiach, S., and Shoenfeld, Y. (2001a), Am J Reprod Immunol 46, 268–273.
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Carp, H.J.A., Sapir, T. & Shoenfeld, Y. Intravenous immunoglobulin and recurrent pregnancy loss. Clinic Rev Allerg Immunol 29, 327–332 (2005). https://doi.org/10.1385/CRIAI:29:3:327
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DOI: https://doi.org/10.1385/CRIAI:29:3:327