Table 3.
Therapeutic options mentioned in different guidelines concerning immunological alterations.
| DGGG/OEGGG/SGGG (2018) | ESHRE (2017) | ASRM (2012) | RCOG (2011) | |
|---|---|---|---|---|
| APLS Therapy | Low dose aspirin plus unfractionated heparin or low molecular heparin starting with day of positive pregnancy test. Aspirin until GW 34+0, heparin 6 weeks post-partum (APLS and non-criteria APLS) | Low dose aspirin starting before conception plus prophylactic dose unfractionated heparin or low molecular heparin starting with a positive pregnancy test | Low dose aspirin and unfractionated heparin | Low dose aspirin plus heparin |
| Thyroid Antibodies | Thyroid hormone substitution therapy can be administered in woman with RPL and latent hypothyroidism i.e., TPO antibodies | There is insufficient evidence to support treatment with levothyroxine in euthyroid women with thyroid antibodies and RPL outside a clinical trial | --- | --- |
| Chronic Endometritis | Therapy of a chronic endometritis can be performed. | - | - | - |
| Immunomodulatory Therapy | Glucocorticoids only in clinical studies in women with pre-existing autoimmune disorder Therapies with IVIG, allogeneic lymphocyte transfer, lipid infusions or TNF-α-blockers should not be performed outside of clinical studies |
Glucocorticoids are not recommended as treatments for unexplained RPL or RPL with selected immunological biomarkers IVIG are not recommended as a treatment of RPL There is insufficient evidence to recommend intralipid therapy for improving live birth rate in women with unexplained RPL. Heparin or low dose aspirin are not recommended to improve live birth rate in women with unexplained RPL |
IVIG are not recommended for pRPL | Immune treatments should not be offered routinely to women with recurrent miscarriage outside formal research studies |
APLS = antiphospholipid syndrome; ASRM = American Society for Reproductive Medicine; DGGG/OEGGG/SGGG = German/Austrian/Swiss Society of Obstetrics and Gynecology; ESHRE = European Society of Human Reproduction and Embryology; IVIG = intravenous immune globulin; pRPL = primary recurrent pregnancy loss; RCOG = Royal College of Obstetricians and Gynaecologists; TNF-α-blockers = tumor necrosis factor alpha blocker.