A High Dose Intravenous Immunoglobulin Therapy for Women with Four or More Recurrent Spontaneous Abortions

Abstract

Recurrent spontaneous abortion (RSA) may have immunological etiology. The aim of this study was to assess the efficacy of a high dose intravenous immunoglobulin (HIVIg) therapy, in which 20 g of intact type immunoglobulin was infused daily for 5 days during early gestation, for women who had a history of four or more consecutive spontaneous abortions of unexplained etiology. A total of 60 pregnant RSA women underwent HIVIg therapy, and the pregnancy outcome was assessed. The live birth rate was 73.3% (44/60). Fifteen pregnancies ended in spontaneous abortion, and one ended in intrauterine fetal death. In 11 of the 15 spontaneous abortions, fetuses had abnormal chromosome karyotype. When the 11 pregnancies with abnormal chromosome karyotype were excluded, the live birth rate was as high as 89.8% (44/49). The HIVIg therapy may be effective for severe cases of unexplained RSA.

Intravenous Immunoglobulin Suppresses Abortion Relates to an Increase in the CD44bright NK Subset in Recurrent Pregnancy Loss Model Mice

“…These results suggested that IVIg specifically affects the uterus at the early phase and a high dose is required for it to be effective in this model. In agreement with our findings, Yamada et al reported a high live birth rate among uRPL patients who underwent high-dose IVIg therapy at the early phase of pregnancy (400 mg/kg for 5 days at gestational weeks 4-7) [6,56], but not in patients who received medium-dose IVIg therapy (20 g/day for 3 days from gestational sac detection) [57]. Thus, it highly recommended that IVIg is administered to uRPL patients as early and as highly dosed as possible.…”

New Paradigm in the Role of Regulatory T Cells During Pregnancy

“…The total Treg cell volume that regulates excessive inflammation might be important for the maintenance of the early gestation phase of pregnancy. A previous report demonstrated that high dose immunoglobulin therapy improved the live birth rate for refractory recurrent miscarriage cases with four or more consecutive miscarriages (90). Other studies also showed the effectiveness of anti-TNF-alfa inhibitor therapy (91).…”

Effectiveness of high‐dose i.v. immunoglobulin therapy for pregnant women with aspirin–heparin‐resistant secondary antiphospholipid syndrome

“…immunoglobulin therapy is known to be practically effective and this therapeutic modality has long been applied to a wide variety of immune‐mediated diseases, including idiopathic thrombocytopenic purpura, Guillain‐Barré syndrome, Kawasaki's disease, and myasthenia gravis . The HIVIg therapy (20 g/d, five consecutive days, total 100 g) for the women who had a history of four or more consecutive spontaneous abortions of unexplained etiology has been developed by the authors’ group, yielding an 89.8% live birth rate . One study first reported successful HIVIg therapy (400 mg/kg/d, five consecutive days at 17 GWs, and two consecutive days at 22 and 27 GWs) in a pregnant woman with APS who had a history of nine RMs .…”

“…16,17 The HIVIg therapy (20 g/d, five consecutive days, total 100 g) for the women who had a history of four or more consecutive spontaneous abortions of unexplained etiology has been developed by the authors' group, yielding an 89.8% live birth rate. 18 One study first reported successful HIVIg therapy (400 mg/kg/d, five consecutive days at 17 GWs, and two consecutive days at 22 and 27 GWs) in a pregnant woman with APS who had a history of nine RMs. 19 A randomized controlled trial that compared LDA plus heparin plus HIVIg (1 g/kg/d, two consecutive days, monthly) with LDA plus heparin therapy in 16 women with APS failed to show differences in their efficacy.…”