ABSTRACT
The concept of immune dysfunction as a basis for miscarriage is attractive. However, while pregnancy has traditionally been viewed as a battle between the semi-allogenic fetus and the mother, in which the fetus and surrounding trophoblast have to evade an immune response if that response is not suppressed. Pregnancy itself is not an immune-suppressed state but one in which the maternal immune system is modulated without suppression. Regardless, immunotherapy has been introduced into clinical practice as a treatment for recurrent miscarriage (RM) based on the hypotheses that either alloimmunity or autoimmunity is responsible for pregnancy failure. In order to critically evaluate the use of paternal or third-party white cell immunization, intravenous immunoglobulin, or cytokine modulation as treatment for RM it is necessary to examine the rationale for their use, and the results that are available. The patient with RM is interested in the results regarding her subsequent pregnancy rather than the theoretical basis.
