[Re-evaluation of immunomodulator treatments for recurrent abortions]

Immunotherapy of spontaneous recurrent abortion is still a matter of controversy. Since 1985, 117 patients were treated in our center. Transfusions of paternal leucocytes (PL) were given to 56 patients and intravenous immunoglobulins (i.v.Ig) to 61 patients. The allocation of the two treatments was not randomised. Respectively 74% and 71% normal pregnancies were achieved. In two cases treated by paternal leucocytes, the appearance of anti-erythrocytes alloantibodies (anti c and anti Jkb + C) was noted. Two patients receiving i.v.Ig had a transient allergic reaction (urticaria). In the five patients presenting with spontaneous abortion in the setting of in vitro fecondation, four normal pregnancies were achieved. These encouraging results from a single center are still to be considered as preliminary but urge us on continuing this approach. One of the drawback of i.v.Ig is their cost. Use of paternal leucocytes constitutes an adequate alternative provided that a strict immunological selection of the father is performed to avoid lymphocyte or platelet alloimmunisation. Our results are discussed in the light of recent controlled studies emphasizing the importance of the placebo effect and in the light of the new concepts in pregnancy immunology (protective action of trophoblastic HLA-G and Th2 cytokines; antagonistic effect of endometrial NK cells.