A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage

Objective: To estimate whether intravenous immunoglobulin (IVIG) improves the probability of a live birth in women with unexplained recurrent miscarriage (RM). Design: A computerized search in Medline, Embase, Central, Ovid Medline In-Process, and Other Non-Indexed Citations Databases and randomized controlled trial (RCT) registries was performed. Abstracts of the American Society of Reproductive Medicine and European Society of Human Reproduction and Embryology annual meetings and reference lists of identified reports were searched. Setting: None. Patient(s): Women with unexplained primary (without a prior live birth) or secondary (subsequent to a live birth) RM. Intervention(s): IVIG or placebo control intervention. Main Outcome Measure(s): Live birth rate per randomized woman. Result(s): Six relevant RCTs were identified including 272 women with unexplained RM. The overall odds ratio for live birth is 0.92, with a 95% confidence interval of 0.55-1.54, indicating a lack of a treatment effect with IVIG. Similarly, IVIG was not found to be beneficial when women with primary and secondary RM were analyzed separately. Conclusion(s): A beneficial effect of IVIG in treatment of RM was not observed. Given the absence of a proven mechanism of action, and the lack of a diagnostic algorithm to identify patients who are likely to benefit from such treatment, IVIG administration for treatment of recurrent miscarriage is not justified outside the context of properly designed RCTs. (Fertil Steril (R) 2011;95:1080-5. (C) 2011 by American Society for Reproductive Medicine.)