Further experience with intravenous immunoglobulin in women with recurrentmiscarriage and a poor prognosis

PROBLEM: Women with three or more unexplained miscarriages have a 60% chanc e of a subsequent live birth. Intravenous immunoglobulin (IVIG) has not bee n conclusively shown to improve this prognosis. This study assessed the eff ect of IVIG in patients expected to have a poor outcome if untreated, i.e. women with five or more abortions, who have aborted after paternal leukocyt e immunization or who continue to abort despite expressing anti-paternal co mplement dependent antibody. METHODS: Seventy-six women received IVIG in a dose of 400 mg/kg body weight , in one day (total 30-45 g) in the follicular phase of a cycle in which pr egnancy was planned. A booster dose was administered when pregnancy was dia gnosed. Their results were compared to an untreated control group of 74 wom en. RESULTS: Thirty-five (49%) pregnancies in treated women have resulted in li ve births or passed their previous stages of abortion compared to 23 (31%) in control patients (P = 0.04). CONCLUSIONS: These figures indicate that IVIG may prevent further miscarria ges in this poor prognosis population. These figures are especially signifi cant considering the doubt concerning the efficacy of IVIG in patients with three miscarriages and therefore a relatively good prognosis.