Positive ANA and Miscarriage

Dr. Vidali discusses the mechanisms by which patients with positive ANA may miscarry even when they do not have active autoimmune disease or abnormal thyroid functioning.

For many patients who are referred to us with unexplained in vitro fertilization (IVF) failures or recurrent miscarriages, all we are able to find is a positive ANA — antinuclear antibody — with no other sign of autoimmune disease. Just the presence of a positive ANA is a sign that the immune system has a high probability of being involved in these pregnancy losses.

Recent literature has shown that populations of patients with recurrent pregnancy loss have a significantly higher rate of positive ANA than the general population. In fact, the association is even higher when the positive ANA is accompanied by a positive antithyroid antibody — even when thyroid function is normal.

Failing to treat these patients for immune-related losses is a critical reason for repetitive failures in many fertility treatments. The reason for this association is not fully understood, but it is believed that these antibodies actually attach to the invading trophoblast of the embryo, triggering the activation of the body’s complement system. When activated, the complement system leads to a massive influx of inflammatory immune cells that begin the destruction of the embryo through a process called apoptosis.

Treatment and Management

There are many treatments available for this, and these losses are usually preventable. Treatment must be carried out even if there are no other signs of underlying autoimmune disease — which, of course, must always be ruled out in patients with positive ANAs.

In patients who are found to have an underlying autoimmune disease, treatment for immune rejection of pregnancies must then be carried out to assure a chance for success. It is also important to point out that a newly positive ANA found during or immediately after pregnancy may be a sign that the immune system was involved in an attempt to destroy the embryo. The nuclei of destroyed embryonic cells generate an immune response, and antibodies to these nuclear components — which is ANA — are produced.

When Surgery May Be Needed

If you have a positive ANA, even if you were told there is no autoimmune disease, you will most likely require careful evaluation and management of your cycle to avoid recurrent pregnancy loss.

In our years of experience, we have also found that for some patients — particularly those with underlying conditions such as Endometriosis or Adenomyosis — surgical intervention can be not only beneficial but often necessary to restore reproductive potential and improve outcomes in conjunction with immunological treatment.

Next Steps

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