Reproductive Immunology in Asia
After years of failed IVF cycles with your own eggs, you have now gone through the long (and expensive) process of using donor eggs to create embryos. You are full of hope for your next embryo transfer; after all, you’ve done everything you can to set yourself up for pregnancy. But your transfer isn’t successful.
The despair of a failed transfer - or several transfers - of your embryo created with donor eggs is hard to overstate. For many people, the standard explanation of “bad luck” doesn’t cut it, and continuing to use precious embryos with the same transfer protocol seems, as the old adage goes, to be the definition of insanity. After this long journey, women facing unexplained infertility and recurrent implementation failure may find their way to a subspeciality that they didn’t know existed: reproductive immunology.
Reproductive immunology explores how the immune system affects fertility and pregnancy. While your immune system usually protects you from disease, in some cases, it can mistakenly interfere with reproductive processes, causing problems with implantation or causing miscarriage. That’s because your embryo is made up of half - or if using donor eggs, fully - foreign genetic material. Your body needs to maintain a complex immune balance to tolerate an embryo, with specialized immune cells and anti-inflammatory signals to help your boyd accept and nurture the pregnancy. Usually, this happens naturally and doesn’t require any additional medical intervention. But reproductive immunologists posit that, when the balance is disrupted, the immune system may treat the embryo like a threat, leading to failed IVF cycles.
Despite being practiced for many years in the USA, reproductive immunology is still a developing field of medicine, and isn’t always widely accepted by reproductive endocrinologists (REs, aka your IVF doctor). Some women, particularly those with known autoimmune disorders, including endometriosis, may be referred to a reproductive immunologist (RI), but most women will go through many cycles before finding their own way to one.
A reproductive immunologist may run tests to evaluate natural killer cell activity, autoantibodies, cytokine levels, and other immune markers. Based on these results, they might recommend treatments such as low-dose steroids, anticoagulants, leukocyte immunization therapy, intralipid infusions, or immunoglobulin therapy to help the body support a successful pregnancy.
While still considered a niche specialty, reproductive immunology is gaining recognition as more people seek answers beyond traditional fertility care. If you’ve been told “everything looks normal” but pregnancy still isn’t happening—or doesn’t last—an RI may offer new hope.
Yet these tests and treatments remain controversial amongst many REs due to a lack of sufficient evidence of their success, like large randomized controlled trials. Advocates of reproductive immunology will say that this level of evidence is difficult to attain given the small number of patients and bespoke protocols that each one requires. While many patients have success with reproductive immunology after many failed IVF cycles, it is difficult to prove that the success was definitively due to these additional therapies and not - you guessed it - luck.
Unfortunately for women in Asia, reproductive immunology and the specialized testing that it relies on is most common and widely publicized in the USA, and to a lesser extent, Canada and Australia. But India, Japan, Korea, China, Taiwan and even the Philippines have practicing reproductive immunologists with their own professional societies.
How can you find an RI? Unfortunately, asking your RE for a referral to an RI can be difficult since many REs take a skeptical approach to the field. Some REs may not be open to collaborating with an RI at all, putting you in a difficult position. Our advice is always to advocate for yourself. If you want another opinion from an RI, contact the professional society in your country and find one nearby. Ask about the tests that they carry out and how they will diagnose and treat you. Be sure to check any medications or treatments that your RI proposes with your primary care physician and your RE to ensure that there are no contraindications or potential negative side effects based on your own health history.
If you want to learn more, we recommend the book, Is Your Body Baby Friendly?: Unexplained Infertility, Miscarriage & IVF Failure Explained, by Alan E. Beer, Julia Kantecki and Jane Reed, for an overview of the field. There are also many excellent Facebook groups and Reddit discussion topics on reproductive immunology to learn from other patients. And while we cannot recommend specific clinics or doctors, we are happy to share our research on clinics that offer reproductive immunology in Asia if you contact us.
