Successful treatment of immunologic abortion with low-dose intravenous immunoglobulin

Fertil Steril. 2000 Mar;73(3):536-40. doi: 10.1016/s0015-0282(99)00572-5.

Abstract

Objective: To evaluate the efficacy of low-dose intravenous immunoglobulin (IVIG) treatment in older women with immunologic abnormalities and recurrent spontaneous abortion (RSA), a condition referred to as immunologic abortion.

Design: Prospective clinical trial.

Setting: Outpatient referral practice.

Patient(s): Forty-seven women were enrolled in the study. The mean age of the women was 37 years (range, 28-45 years), and the mean number of prior miscarriages was 3.7. Immunologic abnormalities included antiphospholipid antibodies (32%), antithyroid antibodies (53%), antinuclear antibodies (28%), antiovarian antibodies (2%), increased natural killer cells (40%), increased immunoglobulin (Ig)M level (28%), and increased CD4/CD8 T-cell ratio (15%). One patient had IgA deficiency, and three women had endometriosis. Thirty-one of the 47 patients (66%) had more than one immunologic abnormality.

Intervention(s): Treatment with IVIG at a dose of 0.2 g/kg within 2 weeks of attempted conception. Once conception was achieved, IVIG treatment was continued on a monthly basis at the same dose through 26-30 weeks of gestation.

Main outcome measure(s): Successful pregnancy or recurrent abortion.

Result(s): Of the 47 women, 36 received initial IVIG treatment, and 24 subsequently became pregnant. Of these women, 20 continued IVIG treatment through 26-30 weeks of gestation, and 19 (95%) had a successful term pregnancy. Four women discontinued IVIG therapy after 10-12 weeks of gestation, and 3 (75%) had a successful pregnancy outcome. Of the 11 women who refused IVIG therapy, 7 became pregnant, and all 7 miscarried. The difference in pregnancy success rate between the IVIG-treated and untreated groups was significant (P=.001). Three women had adverse reactions during the low-dose IVIG infusion, and these reactions resolved when the IVIG brand was changed. Fetal abnormalities were not observed.

Conclusion(s): Low-dose IVIG therapy is beneficial for older women with immunologic abortion. The optimum duration of IVIG treatment in these women requires further study.

Publication types

  • Clinical Trial

MeSH terms

  • Abortion, Habitual / drug therapy*
  • Abortion, Habitual / immunology*
  • Adult
  • Antibodies, Antiphospholipid / blood
  • Dose-Response Relationship, Drug
  • Embryo, Mammalian / physiology
  • Female
  • Fertilization in Vitro
  • Headache / chemically induced
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / adverse effects
  • Immunoglobulins, Intravenous / therapeutic use*
  • Karyotyping
  • Killer Cells, Natural / immunology
  • Maternal Age
  • Middle Aged
  • Nausea / chemically induced
  • Ovary / immunology
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, High-Risk
  • Prospective Studies
  • Thyroid Gland / immunology

Substances

  • Antibodies, Antiphospholipid
  • Immunoglobulins, Intravenous