Skip to main content
SpringerLink
Log in

Pregnancy outcome in couples with recurrent abortions following immunological evaluation and therapy

  • Chapter
Early Pregnancy Loss

Summary

Three hundred and sixty five couples with 3 or more spontaneous primary abortions were immunologically evaluated after their clinical workup and revealed no aetiology for their recurrent losses. One hundred and seventy three women in this group qualified for paternal leucocyte immunisation. The remainder received no therapy. Reproductive performance following workup and therapy revealed: 100/121 women immunised with paternal leucocytes established a pregnancy and delivered live infants; 21/121 aborted an additional time following immunisation. Subsequently these women were immunised twice with HLA incompatible leucocytes from the same non-paternal female donor and were retested immunologically. Of these 15/21 have delivered live infants. Six women aborted their pregnancy following non-paternal leucocyte immunisation. Thirteen/51 women qualifying for and awaiting treatment established a pregnancy and delivered, the remainder aborted an additional time. Twelve couples established a second pregnancy one year or longer following leucocyte immunisation. Six of the women not reimmunised aborted this pregnancy, the six reimmunised with paternal leucocytes delivered a second live infant. We conclude: 1) The incidence of a live born infants in couples with 3 or more spontaneous abortions is very low; 2) Paternal leucocyte immunisation results in an 83% live birth incidence; 3) Reproductive outcome following paternal leucocyte therapy correlates with in vitro immune response profiles; 4) Non-paternal leucocyte therapy is highly successful in women previously failing paternal leucocyte therapy and in women who experienced severe intrauterine growth retardation following paternal leucocyte immunisation. We suggest that this subgroup of 21 couples aborting an additional time post paternal leucocyte therapy may share the same trophoblast lymphocyte crossreactive (TLX) antigens. As a result the female IS incapable of initiating the pregnancy associated responses necessary for the immunoprotection and growth stimulation of the trophoblast. Leucocytes from the non-paternal donor initiated measurable immune responses in most and this response was associated with improved reproductive outcome. The immunological significance of these findings is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Chaouat G, Kolb JP, Wegmann TG. The murine placenta as an immunological barrier between the mother and the fetus. lmmunol Rev 1983; 75: 31–60.

    Article  CAS  Google Scholar 

  2. Chaouat G, Kiger N, Wegmann TG: Vaccination against spontaneous abortion in mice. J Reprod Immunol 1983; 5: 389–392.

    Article  PubMed  CAS  Google Scholar 

  3. Beer AE, Quebbeman JF, Hamazaki Y, Semprini AE: Pregnancy outcome in human couples with recurrent spontaneous abortions: The role(s) of HLA antigen sharing, ABO blood group antigen profiles, female serum MLR blocking factors, antisperm antibodies and immunotherapy. In: lmmunoregulation and Fetal Survival. Eds. Gill TJ, Wegmann TG. New York and Oxford: Oxford University Press, 1987; pp 286.

    Google Scholar 

  4. Menge AC, Beer AE. The significance of human leucocyte antigen profiles in human infertility, recurrent abortion, and pregnancy disorders. Fertil Steril 1985; 43: 693–695.

    PubMed  CAS  Google Scholar 

  5. Beer AE, Quebbeman JF, Ayers JWT, Haines RF. Major histocompatibility complex antigens, maternal and paternal immune responses, and chronic habitual abortions in humans. Am J Obstet Gynecol 1981; 141: 987–999.

    PubMed  CAS  Google Scholar 

  6. Beer AE. Immunopathologic factors contributing to recurrent spontaneous abortion in humans (editorial). Am J Reprod Immunol 1983; 4: 182–184.

    PubMed  CAS  Google Scholar 

  7. Beer AE: How did your mother not reject you? Ann Immunol 1984; 135D: 315–318.

    CAS  Google Scholar 

  8. Beer AE, Semprini AE, Zhu X, Quebbeman JF. Pregnancy outcome in human couples with recurrent spontaneous abortions: 1) HLA antigen profiles; 2) HLA antigen sharing; 3) Female serum MLR blocking factors and 4) Paternal leukocyte immunization. Exp Clin lmmunogenet 1985; 2: 137.

    CAS  Google Scholar 

  9. Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ. Early embryonic mortality in women. Fertil Steril 1982; 38: 447–453.

    PubMed  CAS  Google Scholar 

  10. Warburton D, Fraser F. Spontaneous abortion risks in man: data from reproductive histories collected in a medical genetics unit. Hum Genet 1964; 16: 1.

    CAS  Google Scholar 

  11. Graves WL. Psychological aspects of spontaneous abortion. In: Spontaneous and Recurrent Abortion. Eds. MJ Bennett, DK Edmonds. Oxford: Blackwell Scientific Publications, 1987; pp 214.

    Google Scholar 

  12. Malpas P. A study of abortion sequences. J Obstet Gynaecol Br Empire. 1938; 45: 932–949.

    Article  CAS  Google Scholar 

  13. Eastman NJ. Habitual abortion. In: Progress in Gynecology. (Eds.) JV Meigs, SH Sturgis. New York: Grune and Stratton, pp 262.

    Google Scholar 

  14. James WH. Control data for evaluating the efficacy of psychotherapy in habitual spontaneous abortion. Br J Psychiatry 1963; 109: 81.

    Article  PubMed  CAS  Google Scholar 

  15. James WH. Notes toward an epidemiology of spontaneous abortion. Am J Hum Genet 1963; 15: 223.

    PubMed  CAS  Google Scholar 

  16. MacNaughton MC. The probability of recurrent abortion. J Obstet Gynaecol Br Commonw 1964; 71: 784.

    Article  PubMed  CAS  Google Scholar 

  17. Elias S, Simpson JL. Evaluation and clinical management of patients at apparent increased risk for spontaneous abortions. In: Human Embryonic and Human Death. Eds. I Porter, EB Hook. New York: Academic Press 1980; pp 331.

    Google Scholar 

  18. Warburton D, Fraser FC. On the probability that a woman who has had a spontaneous abortion will abort in subsequent pregnancies. J Obstet Gynaecol Br Commonw 1961; 68: 784–788.

    Article  CAS  Google Scholar 

  19. Stray-Pederson B, Stray-Pederson S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 1984; 148: 140–146.

    Google Scholar 

  20. Terasaki PI, Bernoco D, Park MS, Ozturk G, Iwaki Y. Microdroplet testing for HLA-A,-B,-C and-D antigens. Am J Clin Pathol 1978; 69: 103–120.

    PubMed  CAS  Google Scholar 

  21. Chaouat G, Voisin GA. Regulatory T cell subpopulations in pregnancy. I. Evidence for suppressive activity of the early phase of MLR. J Immunol 1979; 122: 1383–1388.

    PubMed  CAS  Google Scholar 

  22. Mcintyre JA, Faulk WP. Allotypic trophoblast-lymphocyte cross-reactive (TLX) cell surface antigens. Human Immunol 1982; 4: 27–35.

    Article  CAS  Google Scholar 

  23. Nicholas NS, Panayi GS, Nouri AM. Human pregnancy serum inhibits interleukin- 2 production. Clin Exp Immunol 1984; 58: 587–595.

    PubMed  CAS  Google Scholar 

  24. Domingo-Garcia CG, Domenech N, Aparicio P, Palomino P. Human pregnancy serum inhibits proliferation of T8-depleted cells and their interleukin-2 synthesis in mixed lymphocyte cultures. J Reprod Immunol 1985; 8: 97–110.

    Article  Google Scholar 

  25. Suciu-Foca N, Reed E, Rohowsky C, Kung P, King DW. Anti-idiotypic antibodies to anti-HLA receptors induced by pregnancy. Proc Natl Acad Sci USA 1983; 80: 830–834.

    Article  PubMed  CAS  Google Scholar 

  26. Figueredo MA, Palomino P and Ortiz F. Lymphocyte response to phytohemagglutinin in the presence of serum from pregnant women: correlation with serum levels of alphafetoprotein. Clin Exp Immunol 1979; 37: 140–144.

    PubMed  CAS  Google Scholar 

  27. Kim SJ, Christiansen FT, Gosar I, Silver DM, Pollack MS, Dupont B. Frequency of alloantibodies reacting with PHA activated T lymphocytes, unexplainable by known HLA activities. Human Immunol 1980; 4: 347–355.

    Article  Google Scholar 

  28. Konoeda Y, Terasaki PI, Wakisaka A, Park MS, Mickey MR. Public determinants of HLA indicated by pregnancy antibodies. Transplantation 1986; 41: 253–259.

    Article  PubMed  CAS  Google Scholar 

  29. Jerne NK. Towards a network theory of the immune system. Ann Immunol 1974; 125c: 373–379.

    CAS  Google Scholar 

  30. Reed E, Bonagura V, Kung P, King DW, Suciu-Foca N. Anti-idiotypic antibodies to HLA-DR4 and DR2. J Immunol 1983; 131: 2890–2894.

    PubMed  CAS  Google Scholar 

  31. Suciu-Foca N, Rohowsky C, Kung P, King DW. Idiotype-like determinants on human T lymphocytes alloactivated in mixed lymphocyte culture. J Exp Med 1982; 156: 283–288.

    Article  PubMed  CAS  Google Scholar 

  32. Klatzmann D, Gluckman JC, Foucault C. Modification of mixed lymphocyte reactivity after blood transfusions in man. Transplantation Proceedings 1983; 15: 1016–1018.

    Google Scholar 

  33. Clark DR. Local suppressor cells and the success or failure of the “foetal allograft”. Ann Immunol 1984; 135D: 21–24.

    Google Scholar 

Download references

Authors
  1. A. E. Beer
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynaecology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Frank Sharp MD, FRCOG

  2. Department of Obstetrics and Gynaecology, St Mary’s Hospital, Praed Street, London, W2 1PG, UK

    Richard W. Beard MB, BChir(Cantab), MD, FRCOG

Rights and permissions

Reprints and permissions

Copyright information

© 1988 The Royal College of Obstetricians and Gynaecologists

About this chapter

Cite this chapter

Beer, A.E. (1988). Pregnancy outcome in couples with recurrent abortions following immunological evaluation and therapy. In: Sharp, F., Beard, R.W. (eds) Early Pregnancy Loss. Springer, London. https://doi.org/10.1007/978-1-4471-1658-5_46

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-1658-5_46

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1660-8

  • Online ISBN: 978-1-4471-1658-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation