Having to go through one miscarriage can be terribly upsetting; experiencing multiple miscarriages can be devastating. However, depending on the reason for your recurrent pregnancy loss, treatment may be available to help you maintain a pregnancy. Intravenous immunoglobulin G (IVIg) is an intravenous drug given to women prior to conception through to the sixth month of pregnancy. Although it won’t help all women, those who have experienced recurrent pregnancy loss due to autoimmune factors may find that IVIg is just what they need to maintain their pregnancy.
What is IVIg?
Using donor blood that has been washed and processed, IVIg is made up of human-derived antibodies. These antibodies help to keep your immune system from recognizing an embryo or fetus as foreign and attacking it. More specifically, IVIg aids in minimizing the actions of natural killer (NK) cells. Amplified levels of NK cells can prevent an embryo from implanting as well as interfere with the proper development of the placenta, which in turn prevents the embryo from developing normally. All of these factors can result in a miscarriage.
Precisely how IVIg works is not entirely clear. It is thought that the drug may block those antibodies that cause your body to reject a pregnancy. However, it is also speculated that IVIg may work by soaking up and defusing the harmful antibodies that can interfere with a pregnancy.
Who is IVIg Intended For?
In general, women who have elevated levels of natural killer cells resulting in recurrent miscarriages are thought to benefit the most from IVIg treatment. Yet, recent research has also shown a connection between increased natural killer cell activity and antiphospholipid antibodies (APA): it appears that those with APA are more likely to have elevated NK cells.
Typically, women whose miscarriage problems were linked with APA were treated exclusively with heparin and aspirin. Because of the relationship between APA and NK cells, however, more fertility specialists are testing women affected by APA for NK cells as well. If there are elevated levels of NK cells, then these women will likely be treated with IVIg instead of the common treatments for APA.
IVIG Infusion Therapy
In general, IVIg therapy should be started from the first month of pregnancy and continue until the 28th week of pregnancy. However, there is some evidence to suggest that administering IVIg infusions even before pregnancy occurs may be beneficial in preventing miscarriage. IVIg therapy is often done monthly and doses can be given anywhere from one to three consecutive days.
Because IVIg is administered intravenously, to receive this treatment, an IV catheter will be inserted into a vein in your hand or lower arm. This will allow the IVIg solution to slowly drip into the vein and enter your system. Although IVIg can be administered in your home under the supervision of a nurse, the very first time you receive treatment you will need to visit your fertility specialist. The first infusion is always done in a clinical setting under proper supervision in case you experience a severe reaction to the drug.
In order to guard against unpleasant side effects, IVIg infusion must be done slowly. This means that one session can take several hours to complete. However, if you seem to be dealing with the treatment well with minimal side effects, it may be possible to complete treatment sessions sooner. Just how much IVIg a person should receive can vary as dosage is calculated according to your weight.
Side Effects of IVIg Treatment
There are a variety of side effects associated with IVIg infusions. Typical side effects include:
- Fever and chills
- Back pain
- Skin irritation at the site of infusion
- Occasionally, pain in arm during infusion
Just how severely you will notice these side effects depends upon the amount of IVIg you receive and for how long. Generally, those receiving lower, shorter dosages report fewer side effects than those women who receive a three-day dose. In some cases, side effects can take a while to appear, causing a delayed reaction to occur 24 to 72 hours after treatment. Some women notice that they are better able to tolerate the IVIg therapy and experience fewer side effects as they continue with the treatment.
Cost and Success
IVIg therapy can greatly improve your chances of having a successful pregnancy after recurrent miscarriage. Some studies have shown a success rate as high as 80% with IVIg treatment. However, this type of fertility treatment does come with a hefty price tag.
Depending on how much IVIg is required for your treatment, each dose could cost as much as $1500. This means that receiving IVIg therapy during your pregnancy could cost in excess of $10,000. Unfortunately, many insurance companies do not cover IVIg therapy (although it doesn’t hurt to contact your insurance provider to double check). As a result, not every couple will be able to afford this treatment.