Potential of immunotherapeutic treatment for recurrent pregnancy loss

The problem of recurrent pregnancy loss frustrates couples and physicians alike. One major reason for these frustrations is that the precise aetiology of recurrent pregnancy loss is rarely determined during the routine clinical evaluation. In at least 50% of couples, no obvious aetiology is ascertained, and this fact has led many investigators to suggest an immunological cause for the disorder. Various immunotherapeutic regimens have been developed, including paternal leucocyte immunisation and intravenous immunoglobulin. Thus far, properly randomised and blinded trials have shown only a modest benefit from immunotherapy for recurrent pregnancy loss. One major problem is that there are no reliable and reproducible tests to identify any subsets of women with recurrent pregnancy loss who might potentially benefit from immunotherapy. Until there is a better understanding of the basic pathophysiology of recurrent pregnancy loss, all immunotherapies for the disorder will be empirical. Therefore, new immunotherapeutic regimens should be tested in randomised prospective trials prior to general acceptance by the medical community.