Treatments Used in Reproductive Immunology

Our immune systems have deep ties to our health and wellbeing. That’s why it shouldn’t be surprising that our immune systems can have a major impact on our fertility as well.

Reproductive immunology is a field of medicine that studies the ways the immune system helps – or hurts – our ability to have a healthy pregnancy. By looking for signs of autoimmune disease, high levels of inflammation or other immunological issues, reproductive immunologists can develop a fertility treatment plan that’s tailored to your needs.

If you’re considering seeing a reproductive immunologist to help you on your fertility journey, it might be best to familiarize yourself with the different reproductive immunology treatments first. Many clinics have developed their own unique approaches to treatment, but the following list should cover some of the most common treatments you’ll encounter.

Intravenous Immunoglobulin (IVIg)

IVIg, or Intravenous Immunoglobulin, is an infusion therapy containing antibodies separated from donated blood plasma collected from thousands of donors. During an IVIg treatment, a health care provider delivers IVIg by drip infusion over the course of a few hours.

A primary goal of IVIg therapy as a reproductive immunology treatment is to help counteract maternal antibodies against a developing embryo. It is also used to help control certain autoimmune and inflammatory diseases.

Lovenox or Heparin

Lovenox is a low-molecular-weight-heparin (LMWH) blood thinner that is administered daily via subcutaneous injection. It is the most widely used LMWH and is typically used to prevent blood clots and treat venous thromboembolism.

The risk of blood clots increases during pregnancy, which is a potential health threat to both the mother and fetus. Reproductive immunologists often prescribe blood thinners to patients who are at increased risk of thrombophilia (blood clots).

Low Dose Aspirin

Low dose aspirin is an over-the-counter drug that is best known for its daily use in the prevention of heart attacks. It is a non-steroidal anti-inflammatory drug (NSAID) that can be used to prevent blood clots and treat venous thromboembolism.

Low dose aspirin is commonly prescribed during pregnancy and is recommended by ACOG and numerous health agencies for pregnant patients with an autoimmune disease, a history of preeclampsia, or numerous other health conditions. Many reproductive immunologists will prescribe a combination of low dose aspirin with Lovenox or another heparin for fertility patients with an increased risk of thrombophilia.

Metformin

Metformin, commonly sold under the brand name Glucophage, is used as a first-line oral medication to treat type 2 diabetes. It is one of the most prescribed medications in the US.

In addition to being used to treat type 2 diabetes, metformin is commonly prescribed off-label to treat polycystic ovarian syndrome (PCOS). Metformin is sometimes used as a reproductive immunology treatment for patients with signs of insulin resistance, hyperglycemia or high testosterone levels.

Neupogen (Fligrastim)

Neupogen (filgrastim) is an injectable drug that contains a pharmaceutical analog of naturally occurring granulocyte colony-stimulating factor (G-CSF). Treatments are self-administered subcutaneously by the patient at home daily.

Neupogen is typically prescribed to help the body make white blood cells after receiving cancer treatment, but a reproductive immunologist might prescribe Neupogen to help promote immune tolerance.

Prednisone

Prednisone is an oral corticosteroid that is used to suppress the immune system and decrease inflammation. It mimics a hormone naturally made by the adrenal glands, which means that it is not an appropriate treatment for everyone and comes with some risks.

Prednisone is sometimes used as a treatment if the reproductive immunologist suspects that high levels of inflammation are contributing to the patient’s reproductive problems.

Other Medications

Some other reproductive immunology treatments you might encounter include:

• Low dose naltrexone
• Dexamethasone and other steroids
• Plaquenil (hydroxychloroquine)
• Adalimumab (Tumor necrosis factor blocking agents)
• Selective serotonin reuptake inhibitors (SSRIs)
• Intralipid infusions
• Over-the-counter allergy medications (like Pepcid or Claritin)

Supplements and Dietary Changes

In addition to medications, some reproductive immunologists will prescribe nutritional supplements or anti-inflammatory diets. These could include fish oil (omega 3), vitamin D, methylated folate, or other supplements.

Although supplements and some medications can be purchased over the counter, it’s always advised that patients speak to their doctor before starting a new medication or supplement.

Test Before You Treat

Some reproductive immunology treatments are expensive, and a few medications like prednisone come with risks that shouldn’t be taken without good reason. At Pregmune, we believe in the promise of personalized medicine, which means it is essential to test before you treat to determine if you’re more likely to benefit from immunological treatments.

When seeing a reproductive immunologist or other fertility specialist who prescribes immunological treatments, don’t be afraid to ask for the evidence. Your doctor should be able to tell you why each treatment you’re given is specifically appropriate for you. If your doctor’s response is that they’re taking a trial-and-error approach, you could suggest Pregmune’s IRMA report as a more methodical way to help develop your treatment plan.

In the coming months, we’ll be posting some articles looking at the evidence behind specific immunological treatments. Subscribe to our newsletter or follow us on our socials if you’d like to stay informed.

About Pregmune: We’re an innovative reproductive health technology company, built on a solid foundation of data gained from decades of experience and thousands of successful pregnancies. Our team of fertility specialists and scientists are using artificial intelligence to decipher the complexity of the immune system and help patients grow the families of their dreams.

Our first product, IRMA, provides patients and their doctors with a personalized report and evidence-based treatment plan that addresses immunological sources of unexplained infertility, recurrent pregnancy loss, and recurrent implantation failure.