Dr. János Kádár

I am Dr. János Kádár, an internist-immunologist, and the chief physician of the internal medicine department of the St. László Hospital. In my private practice, I provide assistance to those who come to me in the discovery and treatment of autoimmune diseases, recurrent miscarriages, and the causes of infertility.

We speak of habitual miscarriage when three or more miscarriages have occurred under the age of 36, and two or more miscarriages over the age of 36.

With the difficulty of getting pregnant, the unsuccessful “vitro fertilization program” and carrying the fetus, and complaints related to early abortions, it is best to first consult a gynecologist. The immunological causes that can be identified or detected usually represent a small portion of the cases. Even in such cases, the first step should be to seek appropriate gynecological care – the rules of the profession regarding the examination of the immunological background are clear.

Among the immunological causes, the best known is a blood clotting problem leading to a disturbance in the circulation (microcirculation) of the placenta, which may be caused by autoantibodies, and these may lead to an increased tendency to thrombosis. The name of the disease is antiphospholipid syndrome, and the circulating antibody is lupus anticoagulant, which can also develop due to, for example, a so-called anti-cardiolipin antibody.

The other group of immunological factors is much less tangible. In such cases, damage to the mechanisms that dampen or eliminate the maternal immune response may play a role, or perhaps an increased maternal immune response. In habitual miscarriages, immunological blood tests are routinely performed in autoimmune diseases. In such cases, immunosuppression with a low dose of a drug that may eliminate unidentified immunological factors or even anticoagulants may be considered as a solution.

There may be rare genetically determined incompatibilities between the parents, the male partner may have transplant characteristics, as a result of which the mother's body is unable to recognize the foreign fetal structure as her own.

If such cases are suspected, "alloimmune" tests may be performed: they examine how much the immune system of the now healthy woman is rejecting the environment and the partner's cells. This also involves a blood test.

The task of the immunological-internal medicine consultation in this case is to judge whether the woman who wants to have a family does not have some kind of immunological system disease, and therefore may require completely different treatment. If no recognizable disease arises, then we need to discuss what additional diagnostic options there are that have not yet been examined, how these can be achieved, and what can be expected from this. Will conception occur? Will the man's gametes reach the egg?

There are also many cases where no abnormalities can be found, but pregnancy is still not possible. Even then, low-dose aspirin and heparin can be tried, or low-dose steroids may be considered: the latter treatment should often be started after egg rejection, but at the latest after the absence of menstruation.

The question of the immunological aspects of infertility is certainly an area of ​​medicine in which there is still much progress to be made, research is ongoing, and decisive advances can still be expected.