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Patient management tactics in case of incompatibility of spouses
Last reviewed: 23.04.2024
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The question of the importance of compatibility in the HLA system in the habitual loss of pregnancy is one of the most debated in the literature. In the 80 years there were many publications on this issue. It was believed that when compatibility with HLA, especially the locus of DQ, there is no production of blocking antibodies and the whole complex of adaptation reactions to pregnancy does not develop. To enhance the effect of the proposed lymphocyte-immunotherapy cells (LIT) is not the husband, but from the pool of donors.
According to studies, identical antigens of the HLA-A locus occur in 50-69% for pathology and only 34-44% in the control. Identical antigens of HLA-B locus - 30-38% for pathology and 18-28% for control; when the HLA DR locus is identical, 42-71% for pathology and 20-30% for the control. Habitual miscarriage is observed more often than more compatible HLA antigens in spouses. It is recommended to carry out LIT treatment with donor lymphocytes with compatibility of more than 2 antigens. Additionally or independently, vaginal suppositories with seminal plasma, as well as immunoglobulin intravenously, are used.
With HLA compatibility, it is recommended to inject a mixture of donor and paternal lymphocytes on day 6 of the cycle 2 times 2 months before pregnancy or IVF, third time with a positive pregnancy test and repeat every 4 weeks to 10 weeks of pregnancy. In the absence of effect, insemination with donor sperm or IVF with donor egg, or surrogate motherhood is suggested.
With HLA compatibility, it makes no sense to carry out LIT by the lymphocytes of the father. If you perform this treatment, then take the lymphocytes from the pool of donors. But even our small experience testifies to the advisability of carrying out LIT by lymphocytes from the pool of donors before pregnancy and in the first weeks of pregnancy according to the Beer AE technique
Nevertheless, how many supporters of this method are so many and opponents who do not consider alloimmune relationships in general as a reason for miscarriage. The main objection is the absence of randomized studies on the effectiveness of this method of therapy. Comparison with the outcome of previous pregnancies without LIT in the same couples, does not suit these authors.
These studies and therapies, the effectiveness of which has not yet been clearly established, should only be carried out within the framework of the research protocol, after the approval of the ethics committee and with the informed consent of the patients.
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