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Management tactics for incompatibility between spouses
Last reviewed: 04.07.2025
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The question of the significance of HLA compatibility in habitual pregnancy loss is one of the most debated in the literature. In the 80s, there were many publications on this issue. It was believed that with HLA compatibility, especially the DQ locus, there is no production of blocking antibodies and the entire complex of adaptive reactions to pregnancy does not develop. To enhance the effect, it is proposed to conduct lymphocyte immunotherapy (LIT) with cells not from the husband, but from a donor pool.
According to research data, identical antigens of the HLA-A locus are found in 50-69% of cases of pathology and only 34-44% of cases in the control. Identical antigens of the HLA-B locus - 30-38% of cases of pathology and 18-28% of cases in the control; with identity of the HLA DR locus 42-71% of cases of pathology and 20-30% of cases in the control. Habitual miscarriage is observed more often than a greater number of compatible HLA antigens in spouses. It is recommended to conduct LIT treatment with donor lymphocytes with compatibility of more than 2 antigens. Additionally or independently, vaginal suppositories with seminal plasma, as well as intravenous immunoglobulin are used.
If HLA compatibility is present, it is recommended to administer a mixture of donor and paternal lymphocytes on the 6th day of the cycle 2 times 2 months before pregnancy or IVF, the third time if the pregnancy test is positive, and repeat every 4 weeks until 10 weeks of pregnancy. If there is no effect, insemination with donor sperm or IVF with a donor egg, or surrogacy are suggested.
If there is compatibility according to HLA, there is no point in conducting LIT with the father's lymphocytes. If this treatment is to be carried out, then lymphocytes should be taken from a donor pool. But even our limited experience indicates the advisability of conducting LIT with lymphocytes from a donor pool before pregnancy and in the first weeks of pregnancy using the Beer AE method
However, as many supporters of this method, so many opponents, who do not consider alloimmune relationships as a cause of miscarriage at all. The main objection is the lack of randomized studies on the effectiveness of this method of therapy. Comparison with the outcome of previous pregnancies without LIT in the same married couples does not suit these authors.
These studies and treatments whose effectiveness has not yet been clearly established should only be carried out within the framework of a research protocol, after approval by the ethics committee and with informed consent from patients.
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