Questions & Answers
We can only answer some of the many frequently asked questions here. Many questions are specific to the individual situation of each couple, and my team and I will also be happy to provide tailored advice in person.
When does immune diagnostics really make sense?
If you have suffered at least three miscarriages (habitual abortions), or have undergone at least three unsuccessful embryo transfers (repeated implantation failure). Depending on the conditions at your attending fertility centre and other factors, relevant diagnostics may be advisable after only two attempts.
What types of examinations will have had to be done before starting immune diagnostics? It would be essential to have already excluded relevant hormonal causes and anatomical factors as reasons for infertility.
Genetic and haemostasiological factors can also be diagnosed by us in cooperation with other specialist centres.
Who can refer me?
Any doctor – be it your general practitioner, your gynaecologist, or your attending reproduction specialist – can provide referral for immune diagnostics.
Where will I get the prescriptions for recommended treatments after diagnostics have been completed?
Your attending doctor (most likely your gynaecologist or fertility centre) will write your prescriptions for you. These will in most cases be private prescriptions anyway. When it comes to very specific prescriptions, however, these may be provided by us.
Will my husband/partner also have to undergo examinations?
We will always include the husband or partner in diagnostics. The extent of partner testing, however, may vary from case to case. If you have not had any previous children together, the diagnostic spectrum for the male partner may be a bit more extensive.
What effects could autoantibodies have on my unborn child?
As these are for the most part IgG antibodies, they can be transmitted to the unborn child via the placenta. In most cases, this will not pose any risk for your child. For some specific autoantibody situations, we recommend close monitoring of the pregnancy at a centre, and delivery at a maternity hospital with paediatric department and an attending paediatrician.
Immunological diagnostics will also make sense in cases where stimulations only produce a small number of egg cells for collection.
There is no general yes or no answer to this question. It depends largely on the further route you wish to take in your fertility treatment. Since in this situation, there are more and more cases in which so-called “mini ICSIs” or natural ICSIs are possible, a test for specific risk factors may still be advisable.
Can cortisone treatment be harmful to my unborn child?
That will always depend on the prescribed medication. Prednisolone, for example, is able to pass the placenta only in minimal amounts. It is inactivated in the placenta, which means that only small amounts will actually reach the embryo. This would be different with dexamethasone. It easily passes the placenta and therefore reaches the embryo or fetus. This drug is therefore only prescribed in exceptional cases, and only if a treatment of the fetus is desired, for example if the mother presents with a 21-hydroxylase deficiency (metabolic disorder). We will try to avoid prescribing dexamethasone in our treatments of immunological factors.
Will a treatment with fractionated heparin be harmful to my unborn child?
There has been no evidence to date that fractionated heparins, including enoxaparin (clexane), dalteparin (Fragmentin P Forte), or nadroparin (fraxiparin) are transported via the placenta. Fondaparinux (arixtra) is able to pass the placenta only in minimal amounts; there has been no evidence of negative effects on the unborn child to date.
What effects will a treatment with granocyte have on my unborn child?
Granocyte has been the used in treatments for some time now. Scarpellini and Sbracia used it on patients with habitual abortions (recurrent miscarriages). All studies on the subject to date have not established any negative effects on the embryo or fetus.
Will a treatment with immunoglobulins result in an immune deficiency in the unborn child?
Polyvalent immunoglobulins have been used in the treatment of infertile female patients since the 1980s. There has been no indication of negative effects on children whose mothers were treated with immunoglobulins during pregnancy. There have, however, not been any investigations targeting this specific topic.
When is it possible to receive treatment with partner lymphocytes?
If no child has been born from the existing partnership, or if a pregnancy was maintained beyond week 16. Furthermore, there must not exist any medical contraindications.
When is it not possible to receive treatment with partner lymphocytes?
If the patient suffers from autoimmune diseases, or if autoantibodies are found. For reasons of safety, this treatment option will also be discarded in case of any conditions that bear even the slightest chance of risks for later transplantations. This type of treatment cannot be performed if the partner (who in this case is considered a blood donor) is diagnosed with any communicable diseases, or if he presents or had been diagnosed in the past with any diseases that exempt him from being a blood donor.
What kind of reactions can be expected after a treatment with partner lymphocytes?
A slight reddening of the skin at the inoculation site, as well as swelling and mild burning sensation or mild pain is to be expected after about 24-30 hours. A few days later, the site may begin itching. In severe cases, the reaction may entail a swelling of the lymph nodes in the armpit area. Reactions will have peaked after about seven days. It will usually suffice to adequately cool the inoculation site to alleviate symptoms.
Is there anything in particular I should do or not do after immunisation?
There are no specific precautions that need to be taken. You can shower, bathe, or exercise as usual, and also use your regular hygiene products. You should, however, refrain from scratching the inoculation site. In case of a severe itch, simply apply a cortisone-free insect bite gel.
How long after the treatment with partner lymphocytes will I have to use birth control to prevent falling pregnant?
Just like with any other immunisation, your body will need some time to build up the desired reactions. Please avoid getting pregnant from the start of the immunisation treatment until you have serological proof of treatment success.
Will the thyroid hormones and antibodies have to be monitored periodically during pregnancy if I have an immunological thyroid disorder?
The need for thyroid hormones increases by around 30% during pregnancy, which means even a perfectly maintained thyroid can markedly deteriorate. It is therefore advisable to monitor at least the hormone values in intervals of six to eight weeks during pregnancy.
Will there be more laboratory tests of the immunological parameters needed during the course of the pregnancy?
The cellular immune status should be monitored throughout the pregnancy if an increased level of NK cells was diagnosed before the pregnancy. This may also be necessary for planning your therapy during pregnancy. A distinctive stabilisation of the immune situation usually occurs beyond week 12. In individual cases, a monitoring up to the end of the second placenta maturation stage (approx. week 20) will be advisable.
Why can an immunisation with partner lymphocytes not be conducted if autoimmune diseases are diagnosed or if autoantibodies are detected?
In an active immunisation treatment, the immune system is stimulated to create antibodies. This stimulation is, however, not specific, and will trigger a polyclonal immune stimulation. This may result in a titre increase of autoantibodies and in the clinical manifestation of autoimmune diseases.