Intravenous immunoglobulin G in women with reproductive failure: The Korean Society for Reproductive Immunology practice guidelines

Abstract

The task force of the Korean Society for Reproductive Immunology recommends intravenous immunoglobulin G treatment in women with reproductive failure, including recurrent pregnancy loss and/or repeated implantation failure, who show cellular immune factors such as abnormal natural killer cell levels, natural killer cell cytotoxicity, and/or type 1 T helper immunity.

Immune modulation of i.v. immunoglobulin in women with reproductive failure

“…Another study described that IVIg can be a possible additional or alternative therapy in patients with refractory APS with other medications, such as heparin and low‐dose aspirin, or in women who have side‐effects or contraindications to heparin and/or aspirin . However, IVIg cannot be a first‐line therapy for RPLs with APS …”

“…Although IVIg has been reported as an effective therapy for various patients with RF, there is no consensus or established guideline for the indications and treatment protocol yet. Thus, Korean Society of Reproductive Immunology published a guideline for IVIg practice in patients with RF recently (Table ) . According to the guideline, IVIg treatment is indicated in women with RPLs or RIFs and with cellular immune abnormalities, based on the following tests: (i) peripheral blood NK cell proportion; (ii) its cytotoxicity; and (iii) Th1/Th2 cytokine cell ratio.…”

“… NK, natural killer; RIF, Level A, based on a meta‐analysis and/or randomized controlled trials (RCTs); Level B, no RCT and based on case‐controlled studies; Level C, expert opinion and/or clinical experiences of respected authorities; Th, helper cell. …”

“…[90][91][92] However, IVIg cannot be a first-line therapy for RPLs with APS. 93,94 Although numerous efforts have been made, there is no supportive RCT about IVIg that was used in RPLs with autoantibody-mediated autoimmune diseases yet. 70 Recently, one article described a healthy live birth and complete regrowth of the patient's hair by using IVIg in a woman with RPLs with Hashimoto's thyroiditis, which is known as an antithyroid antibody that is mediated by destructive thyroid disease, accompanied by alopecia totalis.…”

“…This study's own cut-off values were determined for cellular im- Table 2). 94 According to the guideline, IVIg treatment is indicated in women with RPLs or RIFs and with cellular immune abnormalities, based on the following tests: (i) peripheral blood NK cell proportion; (ii) its cytotoxicity; and (iii) Th1/Th2 cytokine cell ratio.…”