These data support the concept that unexplained recurrent spontaneous abortion is associated with an increase in Th1-type reactivity, while Th2 dominance is a feature of successful pregnancy.

Concentrations of the T-helper (Th) 1 cytokines interleukin (IL)-2, tumour necrosis factor (TNF) -alpha, TNF-beta and interferon-gamma, Th2 cytokines IL-4, IL-5, IL-6, IL-10 as well as those of soluble CD30 in sera have been examined during the three trimesters of gestation, at delivery in normal pregnancy, and at the time of spontaneous abortion in women with a history of unexplained recurrent spontaneous abortion (RSA). Significantly higher concentrations of the Th2 cytokines IL-6 and IL-10 were found at normal delivery than in women with RSA, and conversely significantly increased concentrations of the Th1-type cytokine TNF-alpha were found in RSA as compared with successful pregnancy. In abortion-prone women who had a successful pregnancy, significantly higher concentrations of IL-6 and significantly lower concentrations of TNF-alpha were found as compared with abortion-prone women who had another abortion, supporting the notion that Th2- and Th1-bias are associated with successful and unsuccessful pregnancy respectively. Serum CD30 concentrations did not correlate with the outcome of pregnancy. These findings support observations drawn from experiments on the cytokine secretion profiles of peripheral blood mononuclear cells and decidual lymphocytes which suggest that normal pregnancy is Th2-biased and that unexplained RSA is associated with Th1-type reactivity.

The aims of this study were to determine the aetiological factors and the pattern of recurrent pregnancy loss in Kuwait. Ninety consecutive patients attending the special recurrent miscarriage clinic were studied prospectively. A comprehensive history of all previous miscarriages and pregnancies, past medical and gynaecological events were established. A physical examination was performed. Extensive investigations were performed. Pregnancies which occurred during the study were monitored carefully. The mean age of the patients was 30.46+/-6.04 years. The patients were subdivided into the groups of secondary (57%) and primary (43%) recurrent miscarriages. Eighty-five per cent of all previous miscarriages occurred in the first trimester. The main aetiological factors were uterine anomaly 2.2%, chromosome anomaly (parental) 2.2%, PCOS, infections and other miscellaneous factors 21.1%, positive antiphospholipid antibodies 33.3% and unexplained in 35.6%. The overall live birth rate was 82% and maternal morbidity was low. Positive antiphospholipid antibodies are the most frequently associated cause of recurrent pregnancy loss in Kuwait.

The fetal and maternal outcome of pregnancies in patients with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome were virtually identical and quite satisfactory. Intravenous immunoglobulin added to the standard therapy resulted in excellent fetal and maternal outcome, although its definitive role will have to wait for the outcome of randomised trials.

Objective: To determine the main causes and management options of infertility in Kuwait. Methodology: Clinical evaluation, hormone profile of LH, FSH, prolactin and testosterone and midluteal phase progesterone, tubal patency tests, semen analysis and antisperm antibodies were assessed. Treatment included medical and surgical induction of ovulation. Male factor infertility was treated with antibiotics and immunosuppression when indicated, and empirically with antioxidants. Results: The main cause of female infertility was ovarian dysfunction (40.7%) with predominance of polycystic ovarian syndrome (52.9%), anovulatory regular cycles (25%) and hyperprolactinaemia (14.3%). Male factor accounted for infertility in 40.2% of the couples, with asthenozoospermia in 34.3%, oligozoospermia in 29.2% and azoospermia in 8.2%. Immuological tubal factors and endometriosis occurred in 9.8, 5.9 and 5.6%, respectively, and unexplained infertility in 8.5%. Both spouses were involved in 36.5% of the couples. Clomiphene citrate was the commonest agent for induction of ovulation with an 80% success rate. Bromocriptine, gonadotropins and laparoscopic ovarian cautery had success rates of 71, 69, and 80%, respectively. Treatment outcome in male factor infertility was variable. Conclusion: Ovarian dysfunction and male factor infertility are the dominant factors responsible for infertility in Kuwait. Induction of ovulation has a good prognosis of 40–80% success rate. Tubal factor infertility is uncommon in Kuwait.