Patients who have failed repeated IVF cycles even though
apparently perfect embryos were transferred, are understandably upset,
frustrated and distressed. They are looking for answers as to why they are not
getting pregnant, and a plausible reason is that their body is
"rejecting" their embryos.
This is why immune testing for patients
with reproductive failure has become very fashionable recently. There is a long
list of expensive tests which many labs now perform - and these include: DQ
Alpha, Leukocyte Antibody Detection, Reproductive Immunophenotype, ANA
(Antinuclear Antibody), Anti-DNA/Histone Antibodies, APA (Antiphospholipid
Antibodies), Natural Killer ( NK) Cell Assay and TJ6 Protein.
This mind
-boggling range of catchy acronyms conceals the fact that no one knows whether
the immune system is really responsible for the failure of the embryos to
implant in these women. Many labs use different protocols to carry out these
tests, which are still poorly standardized. This means that results for the
same test from different labs vary widely, making interpretation very
difficult.
Also, intelligently interpreting these tests in individual patients
is virtually impossible, because of the considerable overlap in the results in
normal fertile women and those who are infertile, since many fertile women will
also have abnormal results when subjected to these tests. Sadly, most labs do
not bother to standardize their test results by doing them on normal fertile
women. This means that if a woman who has had an IVF failure is subjected to
these tests and has an abnormal result, her doctor happily jumps to the
erroneous conclusion that he has now "diagnosed " the reason for the
IVF failure, little realizing that the abnormal result could just be a
"red herring", since "abnormal " results are often found in
"normal " fertile women as well. (These are called " false
positives " - test results which are abnormal ('positive'), even though
the patient has no disease.)
A false positive result causes needless anxiety,
and will often lead to a situation in which the patient will have to undergo
even more tests to prove or disprove the previous results. Remember that if
your doctor performs enough tests on you, it is a mathematical certainty that
he will find something wrong with you. And if he finds something wrong with
you, he'll usually end up treating you - whether you need treatment or not !
