Female genital mutilation (FGM)
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Robert Winston
Fertility expert and one of the world's pioneers of IVF and Fertility Medicine. BAFTA award-winning television presenter and Member of The House of Lords in the UK.
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Fertility in women

Immune screening for implantation failure

There has been a great deal of interest in two antibodies that may affect the way an embryo implants or how an early pregnancy develops. They are anticardiolipin and lupus anticoagulant, which is present in some diseases that change the body’s immune status. Both may be raised in some women who although completely disease-free are prone to recurrent miscarriage.  
In Short
One treatment is to prescribe a daily dose of aspirin, another, which is riskier, is to give heparin.

Heparin thins the blood, preventing clotting and so may promote unwanted bleeding. There is less evidence that heparin is of real value for repeated miscarriage. Some women are also given corticosteroids, often prednisolone. Steroids, too, are not without risk and I feel that this ‘polypharmacy’ is bad medicine, born out of desperation and frustration.

These medicines have been tried with ambiguous results in recurrent miscarriage. So some units try them after repeated failure of implantation after embryo transfer, even when the antibodies are not present. There is an ill-thought out notion that these women may be losing a very early implantation. After nearly 15 years of their use in a number of private clinics, there is still very little evidence that heparin or steroids work. But they certainly may cause complications, including bleeding and gastric ulceration.

In my view, these drugs, including aspirin, are only justified when there is clear evidence that the antibodies are present in abnormal amounts. Even then, they are of dubious value. A trial has found that aspirin may be somewhat beneficial.

In recent years, some private clinics have gone further, with even less evidence to justify their treatment and tried drugs that suppress the human immune system in an attempt to allow the ‘foreign’ protein of any developing embryo to implant. These powerful drugs are usually given for very serious diseases like severe rheumatoid arthritis. Not only can they increase the risk of infection and suppress a woman’s blood count, they are occasionally associated with an increased risk of cancer. Moreover, their effect on any developing baby is not known. As the evidence that they help improve implantation is so weak, I do not think their use in IVF treatments is justified.

The Genesis Research Trust

Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.

Professor Robert Winston’s Genesis Research Trust raises money for the largest UK-based collection of scientists and clinicians who are researching the causes and cures for conditions that affect the health of women and babies.

Essential Parent is proud to support their wonderful work. You can learn more about them here.

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This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.