PMID- 15999561
OWN - NLM
STAT- MEDLINE
DCOM- 20050727
LR  - 20061115
IS  - 0017-7768 (Print)
IS  - 0017-7768 (Linking)
VI  - 144
IP  - 6
DP  - 2005 Jun
TI  - [Intravenous immunoglobulin (IVIG) as treatment for recurrent pregnancy loss 
      (RPL)].
PG  - 415-20, 454, 453
AB  - Miscarriages are the most common complication in human pregnancies. Recurrent 
      pregnancy loss (RPL) could occur for several reasons, such as: immunological 
      abnormalities of the pregnant women and chromosomal abnormalities of the embryo. 
      There are several autoimmune characteristics for RPL, such as autoantibodies, and 
      sometimes RPL are a symptom of an autoimmune disease. It is unclear whether the 
      autoantibodies are the cause, the consequence or an artifact of the RPL. 
      Intravenous immunoglobulin (IVIG) is a preparation made of purified plasma of 
      thousands of healthy donors. Currently, IVIG is provided as a treatment for 
      several autoimmune diseases. There are reports on a beneficial effect of IVIG for 
      women with RPL of unknown reason. Some reports indicate a beneficial effect of 
      IVIG independent of aspirin, as well as in artificial fertilization. 
      Nevertheless, the efficacy of IVIG has yet to be established. Perhaps a certain 
      sub-group should be defined of women who suffer from RPL and have greater odds 
      for successful IVIG treatment. A sub-group analysis showed that, in secondary 
      RPL, IVIG is more successful when provided after embryo implantation, whereas, in 
      primary RPL, IVIG is better when provided prior to conceiving. Apart from the 
      miscarriage type (secondary or primary) other factors that might influence the 
      IVIG-treatment success were found: the number of previous miscarriages, the age 
      of the pregnant women and the way IVIG is administrated. The mechanisms of action 
      of IVIG in RPL are multiple, complex and not fully understood. IVIG therapy 
      regulates the immune system in several mechanisms, in a way that might increase 
      the survival rate of the embryo in the uterus and might decrease the odds of a 
      miscarriage. For example, one of the main mechanisms of IVIG in RPL is 
      down-regulation of natural killer cells (NK cells) activity and expression. This 
      finding is of great importance because it has been reported that women who have 
      never given birth and have high levels of NK cells in their peripheral blood have 
      higher chances of pregnancy loss. In conclusion, IVIG is an immunomodulator that 
      exerts its beneficial effects in multiple mechanistic ways acting together 
      synergistically. IVIG is a potential treatment for women with RPL as a result of 
      immunological abnormalities.
FAU - Sapir, Tal
AU  - Sapir T
AD  - Department of Internal Medicine B and Center for Autoimmune Diseases, Sheba 
      Medical Center, Tel Hashomer, Israel.
FAU - Carp, Howard
AU  - Carp H
FAU - Shoenfeld, Yehuda
AU  - Shoenfeld Y
LA  - heb
PT  - English Abstract
PT  - Journal Article
PT  - Review
PL  - Israel
TA  - Harefuah
JT  - Harefuah
JID - 0034351
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
SB  - IM
MH  - Abortion, Habitual/*drug therapy
MH  - Embryo Implantation/drug effects/physiology
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Immunologic Factors/therapeutic use
MH  - Pregnancy
RF  - 40
EDAT- 2005/07/08 09:00
MHDA- 2005/07/28 09:00
CRDT- 2005/07/08 09:00
PHST- 2005/07/08 09:00 [pubmed]
PHST- 2005/07/28 09:00 [medline]
PHST- 2005/07/08 09:00 [entrez]
PST - ppublish
SO  - Harefuah. 2005 Jun;144(6):415-20, 454, 453.