IMMUNIZATION AS THERAPY FOR RECURRENT SPONTANEOUS-ABORTION - A REVIEWAND METAANALYSIS

Objective: To determine the efficacy of immunotherapy as treatment for recurrent spontaneous abortion (three or more consecutive abortions w ithout an intervening pregnancy of more than 20 weeks' gestation) usin g meta-analysis. Data sources: The search began with MEDLINE and was s upplemented by reference lists from original research, review articles , and textbooks. We also corresponded with investigators and consulted experts in the field of infertility. Methods of study selection: We i dentified four randomized controlled trials and 19 case series reports that examined the use of immunotherapy for recurrent spontaneous abor tion. Data extraction and synthesis: A meta-analysis performed on four randomized controlled trials of leukocyte immunotherapy or trophoblas t membrane infusion revealed a fixed-effects model odds ratio of 1.3 ( 95% confidence interval [CI] 0.77-2.3) and a random-effects model odds ratio of 1.3 (95% CI 0.44-3.8). Conclusion: The quality of evidence r egarding this treatment is class I (best), and the strength of recomme ndation is D (fair evidence against its use). Unless its efficacy can be established through other randomized controlled trials, this treatm ent should be abandoned.