SYSTEMIC CD56+ CELLS CAN PREDICT PREGNANCY OUTCOME

PROBLEM: To evaluate differences in circulating CD56+ cells between su ccessful and unsuccessful pregnancies, 114 pregnant women were studied prospectively. METHOD: Seventy women had a history of infertility (IN F) and 44 had two or more previous spontaneous abortions (RSA). Among the infertile women, 12 were donor egg recipients (DER) and 15 underwe nt intracytoplasmic sperm injection (ICSI) for treatment of male facto r infertility. Nineteen women were carrying multiple gestations (MG) a nd 55 had singleton gestations (SG). Thirteen additional women were re ceiving intravenous immunoglobulin (IVIg). RESULTS: The percentage of CD56+ cells was determined in 310 blood samples from 114 pregnant wome n by flow cytometry. The prevalence of women with persistent elevation of percent of 56+ cells (>12%) was 58% among DER, 73% among ICSI, 37% among MG, 22% among SG, 18% among RSA, and 39% among INF Thirteen wom en with SG received IVIG, 10 had CD56+ cells greater than 12% and all 13 experienced live births, Women with percentage CD56+ cells persiste ntly greater than 12% who were not DER, not ICSI, not receiving IVIg, and not carrying MG had a live birth rate of 11%. Women with greater t han 12% CD56+ cells had normal karyotype in 78% of concepti studied in contrast to women less than 12% CD56+ cells who had 68% abnormal kary otypes (P=0.04). CONCLUSION: Elevated CD56+ cells in pregnant women wh o are not DER, not ICSI, not receiving IVIg, and not carrying MG predi cts loss of a karyotypically normal conceptus with a specificity of 87 % and positive predictive value of 78%. While the specificity value of this test is high in both infertile and RSA populations, the sensitiv ity is 86% in RSA and only 54% in INF suggesting this test does not id entify all losses among INF It may identify a subset of pregnancies at risk for loss of a karyotypically normal embryo that may respond to t reatment with IVIg.