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Results of the survey - Reproductive Immunology Practice in IVF

Results of the survey - Reproductive Immunology Practice in IVF
The concept of 'Reproductive Immunity' and its role in the field of IVF is one of the hotly debated and controversial elements of screening and therapy for IVF treatment. Some elements, such as coagulopathy are less controversial and investigated by many practitioners, other areas are reviewed with skepticism by some but investigated with conviction by others. As always in areas of medicine at the cutting edge of scientific validity there is huge variation in practice and no consensus to its value. It is hoped that this - the first survey of its kind - will obtain an understanding of the extent of its use in IVF centers internationally. If the response merits, a follow up survey will be compiled on the approach to treatment and therapies.

This survey, proposed by: Joanne Kwak-Kim, MD, Director, Reproductive Medicine, Associate Prof. Dept. of Obstetrics and Gynecology, Associate Prof. Dept. of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, and Professor Simon Fishel, Managing Director - Professor of Human Reproduction
CARE Fertility Group, UK.
Data was collected from:
Continent
No. of units
%
No.of cycles
%
USA and Canada
41
18.9  
30800
18.8
Latin America
26
12.0  
13252
8.1
Australia
7
3.1  
10700
6.5
Asia
39
18.0  
27100
16.6
Europe
91
42.0  
72000
44.0
Africa
13
6.0  
9800
6.0
Total
217
100.0
163,652
100.0
 
Majority of IVF physicians understand the importance of reproductive immunology in human reproduction.

 Interestingly, 10% of IVF physicians report no resources for reproductive immunology updates.

Although majority of physicians think reproductive immunology is important for human reproduction, reproductive immunology updates are not easy to get from IVF network or society.
A history of autoimmune disease is taken by nearly half of the reported physicians. However, a history of coagulopathy, family histories for autoimmune disease or coagulopathy are not taken often.   
 Genetic, thrombophilia and reproductive immunology evaluations are often considered by IVF physicians when IVF candidates have a history of RPL or chemical pregnancy losses. 
Autoimmune evaluations are commonly considered as reproductive immunology evaluation for women with RPL.
Thrombophilia evaluations are more commonly evaluated than autoimmune evaluation. 

Karyotype assessment is recommended inover 50% cases if the specimen is available when patients miscarry after IVF treatment.

When a miscarriage after IVF is chromosomally normal, it is interesting to know that 39% of IVF physicians repeat the same protocol.
67% of physicians consider further investigations when 2 IVF cycles resulting in pregnancy losses, and 90% by three losses. But only 7% after the first loss.
  
 
Immunological assessments are considered most often after two failed IVF cycles.  
The evaluation pattern for RIF is similar to RPL however, the frequencies tends to be less. 
Thrombophilia assessments for RIF is similar to RPL however, the frequencies tends to be less.
 

 
In Summary:
It is stimulating to know that the majority of physicians think that the understanding and use of the principles of reproductive immunology is important for human reproduction. The majority of physicians are getting the reproductive immunology information through academic press or journals, although 10% reported no resources. Two thirds of physicians think reproductive immunology update is not easy to obtain through IVF network or society.  
It is interesting to know that genetic, thrombophilic and reproductive immunology evaluations are often considered by IVF physicians when IVF candidates have a history of recurrent pregnancy losses (RPL) or chemical pregnancy losses.
Over half of physicians approach recurrent implantation failures (RIF) in the same way as RPL. Immunological assessments are considered most often after two failed IVF cycles. 
Evaluation patterns for RPL and RIF are similar however, the frequencies for individual test for RPL tend to be more than those for RIF. It seems that physicians are more eager to evaluate immunological abnormalities or thrombophilia in women with RPL than RIF.
Prof. Joanne Kwak-Kim and Prof. Simon Fishel,

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Prof. Zeev Shoham and Prof. Milton Leong