Infertility topics explained by Brian Acacio, M.D.. www.AcacioFertility.com
Acacio Fertility Center, southern California.
Reproductive Immunology is what I call the “black hole” of medical knowledge regarding my field of specialty, Reproductive Endocrinology and Infertility (REI). An issue regarding Reproductive Immunology is the fact that we still know very little about how exactly an embryo signals the uterus and vice versa. We do know there are factors regarding the “rejection” of implantation and that there can be a “hostile” environment even after an embryo implants, but overall, this relationship is poorly understood. Clinically, if this relationship is not a kindred one, it can result in implantation failure (lack of pregnancy) or miscarriage.
Many REI’s decline to acknowledge that Reproductive Immunology is a valid area of study. They cite the fact that about half the studies conducted in this field, show no benefits of therapy. However, this leaves about half the studies showing there are benefits to diagnosing and treating abnormalities when they exist. Those of us that believe Reproductive Immunology is a worthwhile area of analysis would say that the studies conducted that show no benefits either treated in sub-optimal dosages, the wrong timing of treatments (ie-after implantation had already occurred), etc.
Another area of question is how to properly diagnose factors related to Reproductive Immunology. Many times, patients will seek diagnostic testing from laboratories that don’t properly perform the assays. One example of this is the Natural Killer Cell Activity Assay. Laboratories lacking sufficient understanding of how to perform this assay correctly, will simply measure the total Natural Killer cells. This is an improper assessment. It is not the total number or percentage of these cells that dictates their clinical consequences, it is their activity that matters. If this assay is performed properly it can be an important tool to help overcome both implantation failure and recurrent miscarriages.
Once the proper diagnosis is made as to an abnormality related to Reproductive Immunology, then treatment of that condition can be implemented properly. It used to be that dangerous treatments such as Leukocyte Immune Therapy (LIT), wherein the male partner’s white blood cells are injected to the female partner or Intravenous Immunoglobulin (IVIG), pooled blood cells from many different donors has been used. As you may know, LIT is now illegal in the US, due to its risk and lack of success. IVIG is still allowed in the US, but is risky and very expensive (thousands of dollars per treatment). We have been working on new and effective, cost-efficient treatments that are safe. Here at Acacio Fertility Center, we are proud to say we have safely treated hundreds of patients with this new therapy, called Intralipids. Additionally, we have published several peer reviewed articles and presentations at nationally acclaimed professional society meetings demonstrating clear-cut benefits to this new and exciting therapy. Furthermore, we have been among the first and certainly most experienced fertility practice to do so.