[Recurrent spontaneous abortion of alloimmunologic etiology--diagnosis and immunotherapy]

Alloimmunologic mechanisms have been implicated in a number of heretofore unexplained recurrent spontaneous abortions (RSA) and various forms of immunotherapy have been introduced to treat couples suffering from this condition. The treatment most widely used has been immunization using allogenic leukocytes from the partner. This immunotherapy is offered by many medical centers in the USA and elsewhere, although its efficacy remains controversial. Published trials and meta-analyses of published and unpublished studies have yielded conflicting results (success rate 57%-87%). The multicenter study performed under the auspices of the American Society of Reproductive Immunology concluded that contradictory results of investigations could be caused by the heterogeneity of study groups. Because of controversy about the efficacy of allogeneic leukocytes immunization for treatment of RSA, intravenous immunoglobulin as an alternative treatment have been sought. Small number of randomized, controlled trials of IVIG for treatment of RSA have been published. Although these results show that IVIG is effective in the treatment of RSA (live birth rate of 61-85%), it still is not clear what the ideal dosage is, and how frequently and how long IVIG therapy should be given.