Licensed Acupuncturist & Chinese Herbalist
Asheville's Comprehensive Acupuncture Care & Specialist in Fertility, Women's Health and Rejuvenation

Combining an East meets West Approach to the Treatment of Miscarriage

Immune System Problems can Cause Miscarriage

One in two hundred couples will experience two or more consecutive miscarriages. There are five reasons for miscarriage which have been identified:
 
Cause Percent
Infection   1%
Anatomy abnormal   5-10% Progesterone level low   20%
Chromosome abnormal    
- Primary miscarrier (no live births)   7% 
- Secondary miscarrier (one or more live births)   50%
Immune mechanisms   50%
Unknown   15%      

Immune System

Advances in immunology, the study of the body's defense systems, enable us to understand how during pregnancy,  the mother's immune system is altered so that the fetus is not rejected by her body and allows the fetus to grow.

The immune system is comprised of white blood cells, also known as leukocytes, which make a variety of antibodies . Some of the antibodies protect us and others are harmful to our bodies. Some of the immune issues that are important to the reproductive system are:
 
Antiphospholipid antibodies -autoimmune
Antinuclear antibodies -autoimmune
Natural killer cells -autoimmune
Cytotoxic B-cells -autoimmune
Blocking (protective) -antibodies alloimmune
 
When the immune system is the cause of miscarriage, the chances of mother having a successful pregnancy without treatment after three miscarriages is 30%, after four miscarriages 25%, and after 5 miscarriages 5%.

Antiphospholipid Antibodies

Phospholipid molecules are normal components of all cell membranes. Some also have glue like properties and allow cells to fuse (as you will see later). Antibodies to phospholipid molecules can, therefore, cause problems.

Specifically, they can damage the inside of the blood vessel wall. This allows blood cells to stick to the site of the injury and cause blood clots.

Antiphospholipid antibodies can also cause blood vessels to constrict, causing decreased blood flow throughout the circulatory system.

The combination of blood clots and constricted blood vessels may impair blood supply to the fetus and placenta resulting in complete fetal demise or growth retardation.

Some phospholipid molecules have adhesion properties i.e. glue like, and allow cells to fuse. The formation of the normal placenta involves the fusion of small cells called cytotrophoblasts into giant cells known as syncytiotrophoblasts.

The syncytiotrophoblasts play a key role in the regulation of nutrients going to the baby.
One method of treating women with aantiphopholipid syndrome is with acupuncture and herbal medicine. These types of interventions have blood thinning and circulation improving mechanisms which help facilitate the flow of blood to the implanted blastocyst and later, the fully developed placenta.

Antibodies to phospholipid molecules can, therefore, interfere with the development of the placenta.

With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule. Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant.

Aspirin is able to cross the placenta but the dose used is  so small that the fetus is unaffected. The effectiveness of treatment is much greater when the medication, if indicated, is started prior to conception and continued throughout the pregnancy.

All medication, if indicated should be discussed with one's physician.  These medications, especially Heparin or Lovenox are powerful and effective and they work as long as the patient takes them. Herbal medicine however seeks to treat the underlying disease state with a slow, gradual process helping to regulate and normalize immune function permanently.
 
Antinuclear Antibodies The nucleus is the " brain " of the cell. It contains the information that regulates the function of the cell. Some people have antibodies to different nuclear components. What causes these antibodies to be made is currently under investigation. 

The disease that we typically associate with antinuclear antibodies is Systemic Lupus Erythematosus (SLE). The miscarriage rate in SLE patients is much higher than that of the general population.

Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena which is similar to that seen in SLE patients.

The placentas in these women are inflamed and weakened. Acupuncture and the properly designed herbal medicine formula can readily reduce inflammatory states and help mitigate the negative implications associated with anti nuclear antibodies and aid in the prevention of miscarriage.

As the body is dynamic, antibody levels may change over time.  Most people have no antinuclear antibodies all the time. Many women who miscarry have borderline or abnormal levels of antinuclear antibodies.  
 
Patients who develop new autoantibodies like antinuclear and antiphospholipid antibodies during pregnancy have a more guarded prognosis.  This is one reason that we continue to treat patients once they become pregnant. These treatments aid in the facilitation of full term pregnancies.

Treatment of Antinuclear Antibodies

From the Western medical perspective, women with ANA are treated with prednisone, a corticosteroid, which suppresses the inflammatory process and stabilizes the cell. Prednisone does not pass through the placenta easily and is also broken down by enzymes in the placenta so that the fetus is exposed to only trace amounts.

Additionally, the body produces the equivalent of 8 mg per day of this corticosteroid. When indicated, Prednisone should be started prior to conception.  Though prednisone is a safe medication, acupuncture and herbs have a higher safety profile.

Antithyroid Antibodies

In 1990, Stagnaro-Green demonstrated in a prospective analysis that thyroid antibodies were markers for "at-risk" pregnancies. The two antibodies studied, anti-thyroid peroxidase and anti-thyroglobulin antibodies, are collectively referred to as anti-thyroid antibodies (ATA).

Many reports have since corroborated the markedly increased prevalence of ATA in women who experience reproductive failure, especially first trimester miscarriages.

Pratt, et. al., showed that 67% of women with recurrent first trimester losses had ATA, compared to 17% of controls. None of the participants in either group had clinical manifestations of thyroid disease. Although there is a highly positive correlation between the presence of ATA and fetal loss, no definitive pathophysiology has been identified.

Several hypotheses have been proposed to explain this phenomenon. One hypothesis states that these patients have very mild hypothyroidism. Studies to date fail to indicate low thyroid hormone levels in those who miscarried. Proponents suggest that serum hormone levels do not necessarily reflect thyroid dysfunction.

Another opinion is that ATA are markers for predisposition to autoimmune disease, and that the latter is what actually causes the miscarriage. Notable is that ATA is present in up to 45% of patients with systemic lupus erythematosus (SLE).

In another study, 70.8% of patients with recurrent spontaneous abortion (RSA) had various autoantibodies. Antithyroid antibodies appear to be markers for abnormal T-lymphocyte function.

Significant increases in the endometrial T-cell population and the cytokine interferon gamma have been observed in infertile women with ATA.

It can be presumed that infertile patients who demonstrate ATA can be classified as having the reproductive autoimmune failure syndrome (RAFS).  As one of the goals of acupuncture and herbal medicine is to regulate immune function, these modalities are appropriate interventions in conjunction with traditional Western medical approaches.

It seems that acupuncture and herbs potentiate the activity of many Western medical approaches making for better outcomes.

Immunophenotypes: Natural Killer Cells and Cytotoxic B-Cells

The immune system is composed of more than 30 types of white blood cells including neutrophils, monocytes and lymphocytes. Lymphocytes, particularly B-cells (antibody producers), T-cells (helper and suppressor) and killer (NK) cells have been the focus of intense research interest to the discipline of reproductive immunology.

Immunophenotype refers to the relative amounts of T, B and NK cells in the bloodstream.

There is a special class of NK cells (CD3-, CD16-, CD56+) in the placenta that promotes cell growth, secretes growth molecules for the placenta and down regulates the mother's immune response locally at the maternal/placenta interface.

Opposing is another group of NK cells (CD3-, CD16+, CD56+), when activated by the cytokine IL-2, are cytotoxic to placental trophoblast. The same cells secrete tumor necrosis factor (TNF) which can destroy the placenta. Women with CD16+, CD56+ NK cells in excess of 20% are at risk for miscarriage despite optimal immune treatment (paternal leukocyte immunization, prednisone, aspirin and heparin).

In a subset of women who have had multiple failed IVFs, it is believed that TNF is secreted in amounts that inhibit implantation and early formation of the placenta resulting in an IVF cycle which does not produce a clinical pregnancy.  

There are many herbal medicine formulas that are 'anti-toxic' and can help suppress NK cell activity and ameliorate their negative contribution. Combining acupuncture and herbs with IVIg is the most efficacious means of suppression of activated NK cell proliferation.

Inherited Thrombophilias

The Inherited Thrombophilias comprise a group of genetic disorders of the blood clotting pathways, leading to abnormal blood clot formation (thrombi). A common route involves resistance to a natural anticoagulant
called activated protein C (APC).

These diseases have been shown in several studies to cause vascular complications that lead to miscarriage, intrauterine fetal death, pre-eclampsia (toxemia of pregnancy), and the HELLP syndrome which is a severe form of pre-eclampsia characterized by hemolysis (blood cells breaking up), elevated levels of liver enzymes, and thrombocytopenia (a low platelet count).

Women who carry the genes for Inherited Thrombophilias are more likely (2 to 14 times) to have a clotting problem leading to a miscarriage, compared with the normal population.

The three major gene mutations that lead to Inherited Thrombophilias are:
Factor V Leiden mutation.
Factor II (Prothrombin) G20210 gene mutation.
Methylene-tetrahydrofolate reductase (MTHFR) mutation, leading to hyperhomocytseinemia.
 
All of these thrombophilias can lead to miscarriage because they cause lack of blood flow to the placenta; herbs and acupuncture are well know to enhance hemodynamics (blood flow) and serve patients well who present with any of these types of inherited thrombophilias.
 
At The Berkley Center for Reproductive Wellness we have been treating immunological and thrombophilic disorders successfully with acupuncture and herbal medicine for ten years. Our philosophy is that an East meets West approach to reproductive medicine is the new gold standard of care.
 
Experience has shown that by working as a team with you and your reproductive endocrinologist, fertility quotients are increased and miscarriage rates decline.

Your path to radiant health..

Lorraine H. Harris, Licensed Acupuncturist & Chinese Herbalist Specialist in fertility, women's health and rejuvenation, and the only acupuncturist in Western North Carolina (WNC) and Asheville offering Mei Zen™ Cosmetic Acupuncture.

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