Immunological factors in pregnancy wastage: fact or fiction.

Whether maternal immune effector mechanisms with the exception of anti-phospholipid antibodies cause pregnancy loss, and whether effective treatment is possible are subjects of controversy. Hence, in this study the current literature was searched and critically reviewed. In both animals and humans, similar immune effector mechanisms are linked to pregnancy failure. Several levels of evidence indicate that treatments such as aspirin + heparin, intravenous immunoglobulins, corticosteroids, and transfer of allogeneic blood cells bearing paternal antigens may improve the live birth rate. Combination therapy appears promising, but better diagnosis of subgroups responsive to specific therapies is critical. There are fallacies and flaws in the logic of previous arguments against immunological mechanisms and therapeutic interventions. In order to select patients most likely to benefit from known treatments, more extensive immunological testing is required. It is also important to determine the karyotype of all failing embryos.