«Immunologic, Autoimmune Factors, and Recurrent Miscarriage Randine Lewis, Ph.D., Lic.Ac. Reproductive Immunology Autoimmunity is a hot topic in ...»
Medical Articles Medical Article #RL-04
Immunologic, Autoimmune Factors,
and Recurrent Miscarriage
Randine Lewis, Ph.D., Lic.Ac.
Autoimmunity is a hot topic in reproductive medicine these days.
Autoimmunity basically means abnormal immunologic reactions to
parts of our bodies. Allergic reactions fall to one side of this
spectrum, with life-threatening diseases like lupus and multiple
sclerosis at the other end of the scale. What happens in all of these disorders is that the immune system loses its ability to discriminate between "safe" and "harmful." Consider respiratory allergies.
Airborne substances which are inert to most of the general population can cause severe reactions and even death to those whose immune systems are over-reactive. Systemic Lupus Erythematosis, at the other end of the spectrum, presents with an immunologic reaction that attacks major organ systems like the kidneys.
Reproductive Immunology is becoming a very sophisticated discipline, yet few reproductive endocrinologists recognize or treat immunologic factors. Elevated levels of immune markers like antiphospholipid antibodies, and anti-cardiolipin antibodies are thought to be associated with an immune reaction to an implanting embryo. Other markers of potential immunological fertility factors include anti-nuclear antibody, premature elevations of follicle stimulating hormone, lupus anticoagulant, and other clotting factors.
Some of these markers represent a reaction to the husband's "non- self" tissue interacting with the woman's "self" tissue, thereby causing an immune response. Other markers may indicate a woman has antibodies to her own endogenous hormones and neurotransmitters, causing hormonal disturbances including premature ovarian failure.
Since the process of conception and pregnancy involves a suppression of the T-helper immune response so that the woman can carry the fetus to term, any overriding of this suppression can cause the embryo or fetus to abort.
The theory behind treating autoimmune fertility disorders is to reprogram the immune system to not react to self-tissue, and to allow the normal suppression involved in implantation to occur.
The physician who pioneered the treatment of autoimmune infertility, has recognized a characteristic set of patterns in his patients that are diagnosed with autoimmune infertility factors. One of the patterns diagnosed with autoimmune infertility factors. One of the patterns includes the syndrome of migraine headaches along with endometriosis - indicating possible vascular and blood flow abnormalities. Other countries in Asia and Europe have recognized endometriosis as an autoimmune disease for many years.
Typically a woman who is suspected of having a blood component to infertility or habitual miscarriage is given daily doses of aspirin to "thin the blood" and thereby inhibit the clotting pathway. If this is not effective, heparin (another blood thinner) is employed in more severe cases. Because of the side effects of heparin therapy, it is not chosen as the first course of action in treating immunologic infertility.
Intravenous immunoglobulin treatments are used by some physicians to treat severe autoimmunity, and steroids like prednisone are also used to suppress overactive immune systems.
In ancient Chinese literature, a combination of the herbs Dang Gui (Angelica) and Chuan Xiong (Ligusticum Wallichii), were given to women whose periods were late, to either help bring on the menses if she wasn't pregnant. If she was pregnant, these medicinals were to have no effect, and the pregnancy would go on.
The important theory in this approach is that both Dang Gui and Chuan Xiong invigorate the blood. They have the same "blood thinning" effects as Aspirin and Heparin, but are a more natural and harmless approach. Thus, women who are suspected of having an immunologic reaction to the products of conception might be treated with Dang Gui and Chuan Xiong if the symptoms indicate that there is a component of blood stasis in the uterus suspected in early pregnancy. These signs and symptoms might include uterine cramping, a history of dark, clotty menstrual flow, and a pulse whose quality is not smooth, and whose strength seems to come and go in either one or both wrists around the time of implantation and into early pregnancy.
Serotonin is one of the chemicals involved in preparing the uterus for pregnancy. Some women are found to make antibodies to the serotonin in their blood. Dr. Beer, a Reproductive Immunologist from Chicago, Illinois, describes this subset of women with a group of
common symptoms which he has noticed. These include:
Fibromyalgia Increasing depression, irritability, and premenstrual symptoms Early morning insomnia Night sweats over the breastbone Panic attacks Thin uterine lining (less than 8 mm on days 13 or 14) Poor response to high levels of stimulating hormones like Fertinex, Pergonal, Repronex, or Gonal F Hormone levels that crash in the middle of the cycle Hormone levels that crash in the middle of the cycle In Traditional Chinese Medical diagnosis, the above symptoms correspond to a pattern of liver depression qi stagnation, yin vacuity with heart and liver fire. Once again, the particular pattern with which the individual presents must be addressed for full recovery, but a concomitant pattern which is likely to accompany this scenario would be irregular menstrual cycles and a sawthoothed, erratic basal body temperature chart.
A practitioner of Traditional Chinese Medicine would instruct a patient with this presentation to practice stress-relieving techniques like the qi-gong meditation, and daily exercises like walking.
Eat frequent, small meals, to keep the blood sugar level more stable and inhibit the release of adrenalin. Sit down and relax during meals.
Chew all food sufficiently, mixing enough saliva with the food to neutralize it and make digestion easier.
Drink a lot of water, but don't drink during a meal.
Do not drink alcohol or caffeine or smoke cigarettes.
Incorporate the spleen vacuity dietary principles (see below).
Eat foods which move the qi like peppermint, rosemary, spearmint, turmeric, and thyme.
Perform the acupressure techniques to rectify the liver qi.
Supplement with herbs which resolve liver qi stagnation, cool the blood, and supplement the yin. When pituitary and ovarian functions are imbalanced, the heart should be suspect, and if accompanied by other signs of heart disharmony, they should be addressed. One formula which has been used to calm the heart and liver, and can be
incorporated into other prescriptions includes:
Radix Glycyrrhizae Uralensis, Semen Tritici Aestevi Levis, and Fructus Zizyphi Jujubae.
Other herbs which help to calm the spirit include Radix Salviae Miltiorrhizae, Ramulus Uncariae Cum Uncis, and Cortex Albizziae Julibrissin.
Traditional Chinese Medicine has been treating autoimmune infertility for thousands of years. Modern Reproductive Endocrinology has only recognized the impact of immunologic factors for a few years. As with all Chinese Medical treatment, a proper diagnostic pattern must be established before treatment will be effective. The immune system will correct itself when the body is in balance. Many women with previously diagnosed "unexplained infertility" or autoimmune fertility factors have been effectively treated with diet and herbal therapy.
According to the Eastern medical paradigm, it is not so important what the blood marker is, be it + ANA, +ACA, +APA, high FSH, or what the blood marker is, be it + ANA, +ACA, +APA, high FSH, or lupus anticoagulant. It doesn't matter if T cells are low or if natural killer cells are present in the uterus. What matters is the process which initially caused the immune system to go awry. We treat the root problem along with its manifestation, and the immunologic markers in the blood correct themselves.
The Protective Qi Chinese medicine ascribes immunologic functions to an energetic aspect called the protective qi. This protective qi incorporates some of the functions of the spleen and lung systems. Any immunologic aspect, regardless of the physical or symptomatic manifestation, requires supplementation of the spleen qi. Herbs which strengthen the protective qi include Astragalus, Atractylodes, Codonopsis and Dioscorea. The mental process of over concern and worry is said to damage the function of the spleen in Chinese medicine. Meditative techniques can assist in managing the concerns of everyday life and protect the function of the Chinese spleen. Dietary management is probably the most essential element in ensuring proper functioning of the spleen qi. Do not eat cold foods right out of the refrigerator or freezer, too many raw fruits and vegetables, no fruit juices. Do not over consume dairy products, fats, oils, or sweets. An overabundance of wheat can also dampen and impair spleen functioning.
Zhong Yi Fu Ke Lin Chuang Shou Ce (A Clinical Handbook of Chinese Medicine Gynecology) by Shen Shong-li, Shanghai Science & Technology Press, Shanghai, 1990, describes four patterns associated with Allergic and Autoimmune causes of Infertility as
Treatment based upon pattern discrimination
1. Phlegm dampness obstruction and stagnation Main symptoms: Inability to conceive after one year of unprotected intercourse, the woman may or may not be overweight; usually suffering from fatigue, lack of strength, low back pain, heavy lower legs, heavy dragging feeling, profuse vaginal discharge which is white in color and sticky and thick in consistency. There may also be no clinical symptoms except for a sticky, thick vaginal discharge and positive sperm (blood essence) antibodies. The tongue has thin, white coating and the pulse is fine but feels "slippery" or viscous, like there are ball bearings moving through it.
Treatment methods: Fortify the spleen, dry dampness, and transform phlegm
Rhizoma Atractylodis Cortex Magnoliae Officinalis Semen Coicis Lachryma-jobi.
Radix Pseudostellariae Radix Pseudostellariae Rhizoma Acori Graminei Bioe processed Rhizoma Arisaematis Radix Salviae Miltiorrhizae Flouritum Herba Epimedii Sclerotium Poriae Cocos Additions & Subtractions: If sexual desire is low, add Actinolitum
2. Blood Stasis Obstruction & Stagnation Main symptoms: Infertility several years after the woman was married, menstrual movement abdominal pain accompanied by blood clots. The tongue may or not be dark, with static macules on the edges of the tongue or darkened papillae, and the pulse will usually be taut or wiry, like a guitar string and "choppy" - comes and goes, roughly.
Treatment methods: Rectify the qi, quicken the blood, and transform stasis.
Formula: Experiential formula:
Radix Salviae Miltiorrhizae Radix Rubrus Paeoniae Lactiflorae Semen Pruni Persicae Rhizoma curcumae Zedoariae Herba Oldenlandiae Diffusae Rhizoma Corydalis Yanhusuo Pollen Typhae Processed Radix Et Rhizoma Rhei Herba Cistanchis Deserticolae Radix Linderae Strychnifoliae Radix Aucklandiae Lappae mix-fried Radix Glycyrrhizae This would be the type of treatment for women with diagnosed endometriosis, who have the characteristic pelvic pain, clotty, dark menstrual blood, and infertility. They may have higher levels of circulating immunoglobulins found in their blood.
European medical scientists recognize endometriosis as an autoimmune disease.
3. Yin vacuity, fire effulgence
3. Yin vacuity, fire effulgence Main symptoms: Lack of conception after one year of unprotected intercourse, early menstruation, amount profuse, afternoon tidal fever, dry mouth, sore throat, constipation, red eyes, dizziness, tinnitus, low back pain, lower leg weakness, heart vexation, easy anger, thin, a red, dry tongue, and a fine, rapid pulse
Treatment methods: Enrich yin and clear heat to bring the fire down
Formula: Anemarrhena & Phellodendron Rehmannia Pills with
Additions & Subtractions:
Rhizoma Anemarrhenae Cortex Phellodendri Uncooked Radix Rehmanniae Rhizoma Alismatis Cortex Radicis Moutan Sclerotium Poriae Cocos Fructus Corni Officinalis Radix Angelicae Sinensis Radix Scrophulariae Ningpoensis Fructus Lycii Chinensis Fructus Ligustri Lucidi Cortex Eucommiae Ulmoidis Radix Gentianae Scabrae
4. Damp heat pouring downward
Main symptoms: Lack of conception after one year of unprotected intercourse, profuse vaginal discharge yellow in color and possibly with a foul odor, early menstruation, amount profuse or diminished, possible obstructed downward movement, vaginal or rectal itching (especially premenstrual), insidious pain in the lower abdomen which increases with the menstrual period, low back pain, torpid intake, yellow, a red tongue with a slimy yellow coating, and a fine, slippery, and rapid pulse.
Treatment methods: Clear heat, disinhibits dampness, and harmonizes the constructive qi.
Formula: Experiential formula:
Radix Rubrus Paeoniae Lactiflorae Ramuluss Lonicerae Japonicae Fructus Meliae Toosendan Rhizoma Corydalis Yanhusuo Uncooked Radix Glycyrrhizae Beyond the use of herbal formulae to treat immunologic reactions, some health care professionals have recommended the use of PABA (para-aminobenzoic acid) to treat immunologic factors affecting fertility. PABA is a natural substance which is related to the Bvitamins. It is also used topically in sunscreens. PABA effects the formation of red blood cells, protein metabolism and stimulates the production of folic acid in the intestines. Supplementation with 300 mg. of PABA daily has been found to prevent or correct aspects of certain autoimmune diseases like Crohn's disease, ulcerative colitis, scleroderma, and infertility. PABA is found naturally in organ meats like liver, eggs, rice, wheat germ and bran, molasses, and dark green vegetables.
Make sure you include antioxidants (vitamins C, E, beta carotene, selenium, zinc) and super-antioxidants (grape seed extract, pine bark extract, red wine extract, bilberry extract).
Ensure the bulk of your diet consists of whole, organic foods.
Supplement with green foods, microalgae, flower pollen and royal jelly. Include Reishi and Shitake mushrooms, and Kombucha tea.