LABORATORY EVALUATION OF WOMEN EXPERIENCING REPRODUCTIVE FAILURE

Reproductive life table analysis indicates that the majority of reprod uctive failures result from post fertilization failures, whether befor e or after implantation. It is important to have a set of tests to cla rify the diagnosis of the reproductive failure so that appropriate the rapy can be instituted. To determine the frequency of abnormal immunol ogic tests among women experiencing reproductive failure, 108 patients were evaluated for the presence of antiphospholipid antibodies (APA); lupus anticoagulant (LA); thyroid-thyroglobulin and microsomal antibo dies (TGT); embryotoxic factor (ETA); and systemic CD56+/CD16- cells. The frequency of abnormal results obtained from testing for APA, LA, T GT, ETA, and CD56+/CD16- cells among 108 patients with diagnoses of re current pregnancy loss (RPL)(n=45), unexplained infertility (n=45) inc luding IVF failure (n=10), endometriosis (n=10), premature ovarian fai lure (n=5), and polycystic ovaries (n=3) were compared with 15 normal controls. Seventy of one hundred eight (65%) women experiencing reprod uctive failure had at least one positive test, compared to I of 15 (7% ) controls (P=0.0001). Presence of phospholipid antibodies was the mos t frequently abnormal result followed by elevated CD56+/CD16 cells. Th e prevalence of a particular abnormal test varied among the diagnoses. The most frequent abnormal test among women with RPL was an increased percentage of CD56+/CD16- cells (40%), followed by APAs (29%), TGT (9 %), and ETA (7%). The most frequent abnormal result among women with u nexplained infertility was the presence of APAs (42%), followed by CD5 6+/CD16- cells (16%), ETA (16%), and TGT (9%). APA, CD56+/CD16- cells, ETA, and TGT are useful tools to assist in the diagnosis of reproduct ive failure.