Mechanism of Human Chorionic Gonadotrophinmediated Immunomodulation in Pregnancy

Amolak S Bansal; Shabana A Bora; Srdjan Saso; J Richard Smith; Mark R Johnson; Meen-Yau Thum


Expert Rev Clin Immunol. 2012;8(8):747-753. 

In This Article

Therapy With hCG in the Context of RFIVF & Miscarriage

hCG has been used therapeutically in IVF for several years. However, while it may have some benefit in follicular-phase stimulation in reducing FSH requirements,[59] it appears to have only limited benefit in support of the luteal phase. In the latter, it has been associated with a higher rate of ovarian hyperstimulation syndrome.[60] Notwithstanding, hCG support is most likely to be beneficial in those women in whom anti-hCG autoimmunity can be demonstrated. This is more likely in women with thyroid autoimmunity. In each case, the anti-hCG antibodies might reduce the level of free hCG and increasing this level by hCG administration may rescue the pregnancy. Like many receptors, the LH/hCG receptor also exists in a soluble form.[62] While its precise role in predicting ovarian hyperstimulation syndrome and dictating treatment protocols in IVF presently requires further research,[61] the saturation kinetics of the complex would certainly require consideration if hCG was used therapeutically. In the case of women with anti-LH/hCG receptor antibodies, the situation may be more complex and dependent on the precise binding site of the autoantibody in relation to the hCG binding site. Trials would be required to see whether hCG supplementation could overcome the blocking action of these autoantibodies. Alternatively, the use of intravenous immunoglobulin therapy may be worth considering to see whether it could downregulate the action of these autoantibodies via the idiotypic network and B-cell suppression.[62]