Internal medicine immunology specialist examination

Internal medicine immunology helps in the discovery and treatment of autoimmune diseases, recurrent miscarriages and 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. In cases of difficulty in conceiving, unsuccessful “vitro fertilization” 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 fraction of 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.

The best known of the immunological causes 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, and this can also be caused by, 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 that are routinely used in autoimmune diseases are performed. 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 that prevent the mother's body from recognizing the foreign fetal structure as its 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 assess 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 deviation can be found in the end, but pregnancy still fails. Even then, it is possible to try administering aspirin and heparin in small doses, or perhaps consider using low-dose steroids: 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.