Abstract
Background: The aetiology of recurrent pregnancy loss (RPL) is varied and ranges from genetic abnormalities, autoimmune, uterine structural abnormalities, thrombophilic disorders, endocrinologic dysfunction, infective to idiopathic factors. Reproductive immunology may provide an area of opportunity in treatment of idiopathic cases. Research has indicated that any amount of HLA compatibility among spouses leads to immunological perturbations leading to higher RPL rates. These disturbances in alloimmune parameters are found to be significantly reduced after a successful immunotherapy with paternal lymphocytes immunotherapy (LIT) among couples who share HLA.
Aim: To analyze the role of alloimmune factors in couples who are considered unexplained RPL by testing HLA sharing between the partners and to determine the effect of lymphocyte immunotherapy (LIT) on live birth rate in couples with HLA sharing.
Methods: This retrospective observational study was conducted in a single tertiary center in Bangalore for a duration of three years. Couples who satisfied the inclusion and exclusion criteria were selected and HLA sharing between the partners was tested. Couples with HLA sharing received LIT before and during pregnancy. The pregnancy and live birth rates were calculated and compared with couples with HLA sharing who did not receive LIT.
Results: Out of the 199 couples who were screened for HLA sharing among partners, 146 couples had different degrees of HLA sharing. 81 couples received LIT and 32 did not opt for LIT and were taken as control group. The pregnancy and live birth rates were significantly higher in the LIT group compared to control group (77.7% vs 40.6%, p-0.0001, OR 5.1, 95% CI 2.10-11.4 and 56.7% vs 21.8%, p-0.0002, OR 4.6, 95% CI 2.13-13.8 respectively). Miscarriage rates were similar between the two groups.
Conclusion: Partner lymphocyte immunotherapy is a novel treatment option in improving the pregnancy outcomes among women with unexplained RPL and HLA sharing among partners.
Institutional ethical committee registration number- EC/22/000115
Ethical committee approval number for study-EC/OA/46/2023