Tests are not always accurate

Some clinicians believe immmune system abnormalities may be to blame in some cases, and have developed screening tests to identify problems.

But a report by the Royal College of Obstetricians and Gynaecologists (RCOG) warns that they may not work, and says doctors must only rely on proven methods.

It warns that some patients are getting bad advice on unreliable methods from the internet.

Infertility affects one in seven couples and recurrent miscarriage - the loss of three or more pregnancies - affects one in 100 women.

These couples are emotionally vulnerable and there is currently no scientific evidence to justify the use of these tests and treatments Professor Lesley Regan

There are many causes of infertility, and recurrent miscarriage has been linked to genetic defects, hormonal abnormalities, blood clotting disorders, infection and abnormalities of the uterus and cervix.

However, in a significant number of cases there is no obvious explanation for the problems.

Some clinicians believe that these cases may be caused by a malfunctioning of the immune system.

They have developed a number of screening tests and interventions which are based on this theory.

'Major concern'

Many of these are being promoted on the internet to women seeking answers to their fertility problems.

But the RCOG review indicates that, with the exception of antiphospholipid (aPL) syndrome in recurrent miscarriage, which can be treated with aspirin and sometimes heparin, there is no good scientific evidence to support the idea that reproductive failure is due to immunological abnormalities.

Tests examined in report Antiphospholipid antibodies (aPL) Thyroid antibodies Ovarian antibodies Antinuclear antibodies (ANA) Antisperm antibodies Cytokines and Th1/Th2 response Natural Killer (NK) cells Shared parental Human Leukocyte Antigens (HLA)

Professor Lesley Regan, who carried out the review on behalf of the RCOG's scientific advisory committee, said: "The failure to conceive or carry a baby to term can cause considerable distress to a couple.

"It is a major concern to clinicians in the UK that patients are turning up to appointments armed with information downloaded from the web and wanting these unvalidated immunological tests.

"It is clear that the advice given on many sites is strongly influenced by the personal prejudices of doctors practising non-evidence based medicine.

"Much of the data they provide has never been exposed to the rigorous scrutiny of peer review.

"These couples are emotionally vulnerable and there is currently no scientific evidence to justify the use of these tests and treatments."

'Smokescreen'

British Fertility Society chairwoman Professor Alison Murdoch welcomed the review.

"Infertile couples are often desperate to try any possible therapy and it is essential that we only recommend treatments of proven value," she said.

"We support the continuing promising research in this area but new therapies should only be offered as part of an ethically approved controlled trial with appropriate informed consent."

Professor Peter Johnson, head of the reproductive immunology group at the University of Liverpool, said the immune system undoubtedly played an important role in the way the body normally adapted to allow a pregnancy.

But he said much research into infertility and recurrent miscarriage had failed to produce uneqivocal results.

"Clinical investigations and treatments that are without a sound scientific basis mislead patients, often at high cost, exacerbating their emotional roller coaster ride.

"In addition, these empirical approaches can create a smokescreen masking real research advances, to the detriment of future patients."