DQ alpha/HLA Sharing: Does It Always Lead To Reproductive Failure?

23 Oct
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It is not unusual for couples who share DQ alpha/HLA similarities to first give birth to a healthy baby only to subsequently develop infertility, recurrent IVF failure or recurrent pregnancy loss. Such couples find it hard to comprehend how after having experienced an often uncomplicated pregnancy and birth they could then go on to develop immunologic implantation dysfunction. Hopefully, this brief article will serve to explain how and why DQ alpha/HLA sharing between the embryo recipient (female partner) and the sperm provider (male partner) does not inevitably lead to implantation dysfunction and reproductive loss.

When DQ alpha and/or HLA sharing exists between a female and male it will usually require repeated embryo exposures for the host’s uterine natural killer cells to become sufficiently activated to cause damage to the embryo’s root system (trophoblast). Once natural killer cells become activated, they begin to over-produce substances known as TH-1 cytokines which attack the trophoblast and so damage it that the embryo is promptly rejected. Sometimes, the effect is not immediately lethal and the pregnancy “limps along,” only to miscarry, usually in the first trimester. If, in spite of there being DQ-alpha/HLA sharing between the male and female partners, a “competent” embryo reaches the uterus prior to the advent of NK-cell activation (NKa+) it would escape severe damage to its root system and, provided that NKa+ does not subsequently ensue the pregnancy will usually go on to full term. On the other hand, should NKa+ occur, such a pregnancy would likely miscarry. Thus, outcome very much depends on the level and timing of NK cell activation.

The bottom line: In cases of alloimmune implantation dysfunction, it is the frequency and number of embryo-NK cell exposures over time that will determine the absence, presence and degree of NKa+ and so determine the fate of the pregnancy. This serves to explain why successful pregnancies are usually the ones that occur early in the male-female relationship and why subsequently with a progressive build up of NKa+ a successful pregnancy will often be followed by a series of miscarriages and eventually by a complete failure to conceive (i.e. “perceived infertility”).

24 Comments

  • Claire says:

    Hi Dr Sher,

    I am in between cycles, have had 5 IVF cycles and am looking to see what we can do to help our chances on our 6th cycle. I have one daughter from my 2nd IVF FET transfer. Since then, I have had one chemical pregnancy from my 3rd fresh cycle, and one miscarriage at 8 weeks from my 4th fresh cycle. The 4th FET and 5th fresh/FET were total BFN. My IVF specialist (I live in Singapore) has never suggested any immunologic testing or any additional medications like steroids/intralipids. From what I read on your site, it sounds like my husband and I may have immunologic issues. Since we do not have any lab that does the testing here in Singapore, should we go ahead and try the treatment for it? (i.e. intralipid/steroids/prednisolone). Also, do you have an opinion on prednisolone pessaries vs hCG for luteal phase support after fresh transter? I thank you for your time.

    • Geoffrey Sher says:

      Your and your husband’s blood should rather first be sent to the United States (Reprosource Immunology Laboratory, in Boston, MA) for autoimmune and in your case also alloimmune testing (DQ alpha and HLA matching). If the latter is the problem, treatment would have to be modified.

      Please go to the home page of this blog, http://www.IVFauthority.com . When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Unexplained IVF failure”

      5. “Thyroid Autoimmune Disease and IVF”

      6. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      Consider calling 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

  • Michelle says:

    Hi Dr. Sher!

    I thought I posted this question already but can’t find it (sorry!). Anyway, I was advised to start 10 mg of prednisone 3-4 weeks prior to transfer. (partial DQ alpha match) Is this appropriate? I am also doing the IL therapy on CD7.

    • Geoffrey Sher says:

      Yes Indeed!

      Very much so, but you would only need IL therapy if the DQa (p) match is accompanied by uterine natural killer cell activation (NKa+).

      Good luck.

      Geoff Sher

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