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The useful role of an Immunology Unit in a Assisted Reproduction clinic

Dra. Juana Gil Herrera, Inmunóloga Clínica Tambre

The first baby to be born via In Vitro Fertilization (IVF) was Louise Brown in 1978. Since then, the use of Assisted reproduction techniques has grown exponentially. Technological innovations and our improved scientific understanding in this field have attracted a multidisciplinary team of other medical specialists, such as immunology.

What is the relationship between Immunology and Assisted Reproduction?

Immunology is a discipline that focuses on studying how the immune system works to protects us from disease. Immunology applied to assisted reproduction, on the other hand, investigates how various alterations that occur in the immune system can have an effect on the success of a pregnancy.  Pregnancy is an extraordinary process from the immunological point of view. The immune system has a network of cells which protect us against foreign cells. Usually, the immune system does not consider the cells of an embryo to be a hostile organism, even though it is different to us. Regrettably, in some cases, the immune system attacks the embryo instead of protecting it. This prevents pregnancy from developing. This complication appears even in women with good quality embryos and seemingly healthy wombs linings.

Are all patients with difficulties conceiving treated by the immunologist during the first visit?

In the majority of women, this is not necessary. The patients who are more predisposed to developing these adverse immunological reactions are those with existing immunological conditions (e.g. diabetes, celiac disease, thyroiditis).  Sadly, it can also occur is women with no prior health concerns.  The Immunology Unit is a useful service for women with repeated miscarriages (2 or 3) or those who had previous implantation failures with good quality blastocyst embryos.

What are the most cutting-edge Immunological advances in recent years?

What the experts in this department emphasise, is the role of Killer Immunoglobulin-like Receptors (KIRs). It is the activation of these KIRs, along with Natural Killer cells (NK cells) and HLA-C levels, which influence the embryo and placenta embedding into the lining of the womb. This critical event during pregnancy can either positively or negatively influence pregnancy outcome.

Immunological treatment can module this immune response, in the direction of creating a favourable environment for the embryo to implant into the lining of the womb. The two most popular medications used in this treatment is gamma globulin and heparin. Heparin is particularly useful for women with antiphospholipid syndrome, as this improves blood circulation, which increases the chances of pregnancy and decreases the risk of miscarriage. 

Clínica Tambre was the first Spanish assisted reproduction centre to incorporate a Reproductive Immunology Unit. Services like this, led by Dr. Juana Gil Herrera, are those that make Tambre a pioneer in this cutting-edge technology.