Understanding why becoming pregnant or carrying a baby to term is difficult should be a key factor in deciding whether or not to go ahead with assisted conception.
Beginning fertility treatment can be a daunting process – from both an emotional and financial perspective, so, managing expectations is very important from the beginning.
Identifying underlying issues is important
I believe that recommending treatment without undertaking investigations, such as blood tests and scans, is completely wrong because in some cases it can add more pressure – both financially and in terms of time. It can also create false expectations.
A couple may embark on treatment thinking, ‘I’ve got IVF now, I’m going to get pregnant’ but that may not be the case because of an underlying problem, which means they are as infertile with IVF as they are trying to conceive naturally.
It is not unusual for patients to be referred to me having already had several rounds of failed IVF treatment using donor eggs, sperm, or embryos, but still with no clear idea of why their pregnancies failed. This happens quite frequently and transferring a donor embryo or an embryo with donor sperm, may not overcome the problem if there is an underlying issue with the female partner.
Are Natural Killer Cells to blame?
There is research suggesting that ‘Natural Killer Cells’ in some patients could be responsible for implantation failures and miscarriage.
Natural Killer Cells are very important to our bodies. These are a type of lymphocyte, or white blood cells that are critical to our innate immune response. They control our immune system and are responsible for protecting our body from any external assault, providing a rapid immune response to any cells or organisms that may invade our body. They are especially unique in the way they work because they are faster than any other type of immune cell.
While we need them to safeguard ourselves, in some cases raised Natural Killer Cells may prevent an embryo from implanting, acting as the controller of the barrier between the embryo and the uterus.
They can be detected via a blood test, or by taking a biopsy of the lining of the endometrium (the mucous membrane lining the uterus) and sending it for further analysis.
However, even if they are detected in a patient’s blood, they are not always found inside the uterus. In my professional opinion, if there is a history of repeated implantation failure and recurrent miscarriages, and Natural Killer Cells have been found in your blood, it is indicative that there is an environment inside your body that is trying to protect you.
Treatment for this is still controversial and must not cause harm. We can’t lower the immune system, as it can cause wider health issues. I would normally prescribe low dose steroids, while discussing the potential side effects and next steps with my patient.
I recall a recent case, involving a young, fit, and healthy couple who’d had repeated failed cycles of IVF. They had been recommended to keep going, which was putting a lot of pressure on them. The female partner was known to have a thyroid disease. The thyroid is an important gland controlling the immune system, but she’d never undergone investigations for thyroid related disorders. There would be no benefit in embarking on IVF treatment – an emotional journey, which was already taking its toll, if further investigations and proper treatment for an underlying thyroid problem, could mean they’d achieve a pregnancy naturally.
Patients should always discuss all options with their consultant at their very first meeting before IVF begins, so they can work together to create a diagnostic protocol to identify any potential cause, or causes, of failed conception, and what the treatment might be.
Professor Luciano Nardo is Founder of NOW-fertility. He is board-certified in obstetrics, gynaecology and reproductive medicine and surgery. He has 20 years of clinical practice and academic focus on assisted conception, male and female infertility, reproductive endocrinology, miscarriage, and all aspects of benign gynaecology.
