Royal college warns against “unsound tests” for infertility

Women seeking answers on the internet for their fertility problems are being misled by being offered clinical investigations and treatments that lack any sound scientific basis, says a review published this week by the scientific advisory committee of the Royal College of Obstetricians and Gynaecologists.

Figure 1.

Praying to Artemis of Ephesus, a goddess associated with fertility, might be as useful as undergoing some of the fertility tests offered on the internet

Credit: BAL/ALINARI

The review addressed the hypothesis that some cases of reproductive failure (failure to conceive or carry a pregnancy to term) might be caused by immunological abnormalities. Although many of these tests are routinely offered to patients in clinics and are available on the internet, they have so far not been properly validated in well designed research.

The review examined the evidence for a battery of immunological tests, namely anti-phospholipid antibody; thyroid antibody; ovarian antibody; anti-nuclear antibody; and antisperm antibodies.

The authors also looked at tests of natural killer cells and shared parental human leukocyte antigen (HLA). Finally, they considered a test that looks at the balance of the response between two subsets of CD4 T helper cells (Th1 and Th2). (It is thought that the balance between Th1 and Th2 cytokine response is important in pregnancy.) Several immune therapies were also examined.

The review found that among all the tests and therapies offered, the only treatment that was validated by current research was aspirin and heparin for antiphospholipid syndrome in women with recurrent miscarriage; this treatment should be offered routinely to these patients, the review said.

In the case of antiphospholipid syndrome in recurrent miscarriage, the antibodies are thought to have a deleterious effect on embryonic implantation, trophoblast function and differentiation, and later in pregnancy, on placental thrombosis.

Professor Lesley Regan, who carried out the review on behalf of the Royal College of Obstetricians and Gynaecologists' scientific advisory committee, said: “The failure to conceive or carry a baby to term can cause considerable distress to a couple. It is a major concern to clinicians in the UK that patients are turning up to appointments armed with information downloaded from the web and wanting these unvalidated immunological tests.

“It is clear that the advice given on many sites is strongly influenced by the personal prejudices of doctors practising non-evidence based medicine. Much of the data they provide has never been exposed to the rigorous scrutiny of peer review. The couples are emotionally vulnerable, and there is currently no scientific evidence to justify the use of these tests and treatments.”