IVIG Improves Live Birth Rate in Women with Immune Conditions and Recurrent Pregnancy Loss: Review and Meta-Analysis 

Encouraged by recent data suggesting intravenous immune globulin (IVIG) might be more effective in a subgroup of women with recurrent pregnancy loss (RPL) who additionally have an aberrant immunological profile, Dutch investigators conducted a systematic review and meta-analysis of studies on the effectiveness of IVIG treatment of this specific population.

Included among underlying immunological conditions in women with RPL were elevated NK cell percentage, elevated Th1/Th2 ratio and diagnosis with an autoimmune disorder. Eight nonrandomized controlled trials, including a total of 478 women (intervention: 248; control 194) met eligibility criteria.

A meta-analysis showed that treatment with IVIG was associated with a two-fold increase in the live birth rate (relative risk [RR] 1.98, 95% confidence interval [CI] 1.44-2.73, P < 0.0001). The effect of IVIG was particularly marked in the subgroup of studies including patients based on presence of elevated (greater than 12%) NK-cell percentage (RR 2.32, 95% CI 1.77-3.02, P < 0.0001), as well as in women who started IVIG therapy prior to or during the conception cycle (RR 4.47, 95% CI 1.53-13.05, P = 0.006).

The investigators noted, however, that “these results should be interpreted with caution as the studies are limited by low number[s] of participants and the nonrandomized design, which represent serious biases.” They advocated for future randomized controlled trials in women with RPL and underlying immune conditions before using IVIG in a clinical setting.