FertilityZone

“About half of my patient population comprises healthy couples who make beautiful embryo;s in the test tube. But when these embryo’s are transferred to the uterus, they just “wither on the vine”. The average individual I see has been through IVF three times, has spent alot of money, feels angry and let down by the medical community and is looking for answers”.

Having studied immune-mediated implantation failure over 25 years, I believe no one in the world has more data on this subject. The incidence of Category 1 and Category 5 immune problems is 60% for those who have failed their second IVF. For women failing their fifth IVF there is 100% incidence of excessive NK cell numbers and /or activity. Effective treatments are available to deal with this. I truly believe that in a perfect world, IVF successes should equal 50% parenthood per cycle. This is the figure I quote for women who have failed three cycles prior to seeing me”.
-Alan E.Beer MD

Studies have reported that many couples consider infertility to be at least as, or more stressful than divorce or the death of a loved one, with up to half of infertile women feeling depressed and anxious. Defined as the inability to conceive after a year (including those trying for second child), infertility now affects between 10 and 25% of all couples. A rate of over 30% has even been reported in Poland.

For those with normal fertility levels the maximum conception rate each month is between 20 and 25%. After two years of failing to conceive, approximately 5% of couples will have virtually no chance of becoming a parent naturally and for many of these couples IVF represents their only hope of success. However, the likelihood of a positive outcome depends on what kinds of tests and treatments are available to them. When Dr Beer works in association with fertility clinics that advocate immunological testing , the success rate for such cycles is 50-60%. Without such intervention, the success rate of IVF is low, with only one in five or ten embryos developing into an ongoing pregnancy.

On average, only half of all embryos are chromosomally normal. It is likely that of the remaining 50% of good quality embryos, may are being “wasted” on failed cycles, caused by the same immune mechanisms that cause recurrent losses. Dr Beer has found that women incorrectly diagnosed with unexplained infertility before their first IVF attempt have a high incidence of immune problems that cause implantation failure or miscarriage. Following their third unexplained IVF failure, a high percentage of these women will have overactive natural killer cells and an immune etiology for their losses. Even so, many doctors will not consider this possibility if a woman cannot conceive and will probably attribute her negative cycles to poor quality embryos or a lack of necessary hormones.

Some doctors may suggest preimplantation genetic diagnosis (PGD) to weed out chromosomally abnormal embryos. However, it is statistically unlikely this will be the cause of such recurrent failuresr Beer says “I have never seen one patient whose repeated implantation failures were solely due to chromosomal factors. Testing for genetic problems is another thing that fertility clinics offer when they do not know what is wrong.”

Repeated IVF failures can take their toll physically, emotionally and financially. Yet many couples still persevere, despite feeling victimised and angry about their lack of process. If they do not conceive after five or more attempts, donor eggs may be suggested. However, even if both donor eggs and sperm are used, pre-existing immune problems make it more likely this second-level option will also result in disappointment.

Immune problems associated with infertility and implantation failure tend to be more severe than those associated with miscarriage. For couples like these Dr Beer recommends that the woman has an endometrial biopsy on cycle day 26 to detect the present of any harmful immune cells in her uterus. A comprehensive NK cell assay (a type of blood test), cytokine testing and other blood tests will also be required. Following a detailed assessment of the results, an appropriate therapeutic regime can then be devised.

Whenever possible, he advises couples to try and conceive on their own with immune therapy for two cycles before returning to their fertility centre. Indeed, many couples diagnosed as infertile find they do not need IVF at all. As Dr Beer says “Of my patients who have never been pregnant and have failed three IVF cycles, 30% end up getting pregnant on their own when treated immunologically”.

“As much as 40% of unexplained infertility may be the result of immune problems, as are as many as 80% of “unexplained” pregnancy losses. Unfortunately for couples with immunological problems, their chances of recurrent loss increase with each successive pregnancy”
-Carolyn B Coulam, MD “Immunology May Be Key to Pregnancy Loss”

The term “recurrent miscarriage” is used when a woman miscarries twice in a row before 20 weeks gestation. In the past, authorities have recommended this term be used for three or more consecutive miscarriages. However, there is now a tendency to classify them as recurrent after just two, with approximately 1 in 25 couples fitting this category. Most Ob/Gynae’s or reproductive endocrinologists tend to attribute these miscarriages to “bad luck” and will say that the baby was probably abnormal. The American College of Obstetricians and Gynaecologists claims, “between 35% and 85% of couples with an unexplained recurrent pregnancy loss who do not receive treatment...eventually will go on to have a successful pregnancy”. The scope of this estimate is so wide ranging as to be virtually meaningless. In fact, it is now known the women who lose a chromosomally normal baby are at greater risk of a recurrence. Moreover, the likelihood that the foetuses being lost are chromosomally normal increases with the number of miscarriages a woman experiences.

In an analysis of clinical trials, it has been found that the risk of miscarriage in a first pregnancy is 11% to 13%. In a pregnancy immediately following that loss, the risk of miscarriage is 13% to 17%. But the risk to a third pregnancy after two successive losses nearly triples to 38%. Professor David Clark at McMaster University in Ontario Canada goes even further, saying that in a subset of recurrent miscarriage patients the risk is nearer 100%.

As far as genetic causes for recurrent losses are concerned the incidence of parental chromosome rearrangements may actually be quite small. For example, one study found that just 3.6% of 500 couples with recurrent miscarriage had such problems.

Dr Beer declares “I have seen very few chromosomal abnormalities in women experiencing repeat implantation failure or pregnancy loss, certainly nowhere near the 50% level that is regularly quoted”. According to his records, 75% of women who have had three or more losses have autoimmune problems that are associated with reproductive failure. As an additional concern, he has also observed that miscarriage is not just a benign process: it can indicate an underlying health condition associated with autoimmune disease, and may even aggravate or cause such problems.

When immune system dysfunction has been identified, the chance of carrying a baby to term without immunotherapy after three miscarriages is 30%, after four miscarriages 25% and after five miscarriages 5%. Furthermore, if the pregnancy does continue without proper therapy, the baby is automatically at greater risk of premature birth or other potentially fatal pregnancy complication.

It is important that immunological disorders are identified early, as there can be serious implications for the health of both the mother and baby if these disorders are left untreated during pregnancy.

Dr Beer has found that patients who test positive for immune issues tend to fall into distinct groups and have experienced any number of the following:

General Health Problems:

Previous immune problems (e.g. rheumatoid arthritis of lupus)
A thyroid condition
Insulin resistance
A family history of stroke, heart problems or autoimmune disease (e.g. rheumatoid arthritis)
Chlamydia
Fibromyalgia
Chronic fatigue syndrome

Fertility and/or Reproductive Problems:

Unexplained infertility
Poor egg production from a stimulated IVF cycle (less than 6 eggs)
Three miscarriages of IVF failures before the age of 35
Two miscarriages or IVF failures after the age of 35
Miscarriage of a normal baby without a known cause
Endometriosis or any kind of pelvic inflammation
The birth of one or more children followed by miscarriage or infertility (referred to as secondary infertility)

Problems in a Previous Pregnancy:

Unexplained uterine bleeding in pregnancy (especially in the first trimester)
Cervical incompetence
Preterm labour
Premature rupture of the membranes
Preeclampsia
Retarded fetal growth