- Pregnancy and the immune system
- About RIC
- Tests available for patients
- Recognising the need for an
NK cell test - Reproductive immunology testing
- Doctor recommendation of testing
- The cost of testing
- Getting an NK cell test done
- GP Blood Sampling
- Time for Results Availability
- Obtaining the Results
- Understanding the Results
- Blood test request and consent form
- Download RIC for Patients Leaflet
RIC for Patients
Pregnancy and the Immune System
From the implantation of a fertilised egg to the delivery of a healthy baby, the maternal immune system has a major impact on the survival and development of the foetus. For successful pregnancy, the mother's immune system has to tolerate the immunologically foreign foetus, making the maternal environment potentially immunologically hostile.
The inability of a healthy woman to get pregnant or to suffer recurrent miscarriage has a number of causes, including chromosomal/genetic abnormalities, uterine problems and endometrial infection. When these have been excluded, exaggerated maternal immune activity is considered of prime importance. This exaggerated activity is apparent in several cells associated with the immune system. For instance, when the maternal immune system is overly active, NK and T cells are implicated or, in the case of anti-phospholipid antibody syndrome, B cells producing antibodies are involved.
Checking for increased or abnormal activity of these cells and the exclusion of autoimmunity (an immune response against the body's own tissues and foetus) allows timely pharmacological intervention that is critical for reproductive success.
The role of NK and T cells is particularly important and provides the core of our testing. For further information on the role of these cells, as well as other immunological components affecting pregnancy, please refer to the information available in the Educational Material.
About the Reproductive Immunology Centre
The Reproductive Immunology Centre (RIC) is based in Croydon and offers a comprehensive laboratory assessment of NK and T cell function as well as other immunological parameters, such as the functioning of the antibody system, in women with unexplained infertility.
RIC is well established and is one of only three laboratories in the world that provides in-depth analysis of the immune system in the field of infertility. Our services are used by many fertility specialists around the country, as well as several other laboratories lacking our expertise.
An extremely important characteristic of RIC is our programme of ongoing research and development, which builds on many years of earlier work that has been published in several peer-reviewed journals. This research continues to provide evidence which supports the benefits that our tests offer the clinician in the investigation of unexplained infertility.
Tests available for patients
Besides the NK cell tests (NK activation and cytotoxicity) we also offer a range of other tests analysing cells and antibodies implicated in infertility. These include:
- Tests to compare the suppressive effects of steroid, IVIg and intralipid on NK cell killing
- Th1/Th2 cytokine assay
- Anti Nuclear Antibody and subsequent testing for ENA and DNA antibodies if required
- Anti Thyroid Peroxidase Antibody
- Anti Cardiolipin Antibody (Both IgG and IgM type antibodies)
- Lymphocyte Subsets
We can also screen for mutations associated with abnormal coagulation systems which may have an affect on pregnancy.
- Factor V Leiden Mutation
- Prothrombin Gene Mutation
We are currently working on developing an assay to measure Treg and Th17 cell levels.
Recognising the need for an NK cell test
Your fertility specialist will be able to assess which tests are likely to be helpful in the management of your particular clinical problem.
The tests allow your fertility specialist to see if your NK cells are overly aggressive towards your embryo. Further testing can also assess which of the currently available therapies are best able to reduce the activity of these cells and thus may lead to improved pregnancy outcomes.
It should be noted that not all these tests are recommended by the Human Fertilisation and Embryology Authority (HFEA), the Royal College of Obstetricians and Gynaecologists (RCOG) or the American Society of Reproductive Medicine (ASRM) as the research community is divided in the interpretation of the data. With more research being required in the field of reproductive immunology, the tests offered are still considered research tests by some and you should be aware of this.
Supporting evidence for reproductive immunology testing
Research published by RIC in many of the leading fertility journals has shown that the absolute numbers of NK cells have no influence on the outcome of pregnancy following IVF. However, we and others have published results showing that abnormally high levels of activated (CD69+) NK cells or increased NK cell killing is associated with a reduced rate of successful pregnancy following IVF.
In addition to demonstrating the effects of NK cells on fertility, we have also shown that certain changes in T cell subsets are more frequent in those with recurrent failed IVF. Furthermore, research has shown that specific drugs can reduce unhelpful anti-fertility NK cell activity. These findings have been confirmed by other centres around the world.
For up-to-date NK and T cell literature, please see the Research and Development content on this site.
Doctor recommendation of testing
There may be several reasons for why your doctor has not suggested these tests before, including:
- the lack of awareness of the availability of scientifically confirmed tests by an accredited laboratory in the UK.
- your specialist may have been pursuing purely non immunological causes for your infertility.
- some doctors may feel that the research literature is not sufficiently compelling at present and await further evidence.
- alternatively, they could have a lack of knowledge in the area of reproductive immunology.
Patient Testing Costs
For information on the price of the NK cell test and other reproductive immunology testing, please refer to the Prices & Payment page on this site.
Unfortunately infertility treatment is almost never covered by private insurance and RIC is not aware of any of the leading UK private insurance companies supporting the cost of the tests or of the subsequent treatment.
Getting an NK cell test done
RIC advises all women to discuss the full details and implication of the NK cell testing with their specialist before making a decision. Your specialist will be able to advise you whether it is appropriate for you to have the testing done or not. They will also be able to contact us to arrange the blood test.
There is a limited phlebotomy service at the RIC laboratory that can be organized via the enquiries@ri-centre.co.uk email.
Other options available include The Doctors Laboratory where a blood test request and consent form can be completed and taken to The Doctors Laboratory (TDL) patient reception in 76 Wimpole St (see website for times of opening and directions: http://www.tdlpathology.com/services-divisions/patient-services ). This form will need to have been signed by a medical Practitioner.
Signing the blood test request and consent form will constitute your consent to have the blood taken and the various tests performed, as well as your agreement to pay for the tests. It is therefore very important that you take this form with you when you attend for your blood test.
TDL will collect the required blood sample from you and will have the sample and the form couriered to our laboratory for immediate testing. This form will need to be signed both by yourself and your GP.
If you have any concerns or problems about this process, please do not hesitate to contact us.
For further sample requirements, please see RIC for clinicians.
GP Blood Sampling
Your local GP or nurse can also take the blood sample. However, it is critical for the sample to get to us within 8 hours. Any delay beyond 8 hours affects the accuracy of the results owing to increased cell death. Please click here for blood test request and consent form. This then needs to be signed by both you and your Doctor. Both the form and sample should then be sent immediately to our laboratory for testing. A courier may be required for the transportation.
Please note that the cost of taking the blood sample and any transportation charges here are payable by the person whose sample is being analysed or their representative.
Time for Results Availability
The NK and Th1/Th2 cell test results will be available after 48 hours.
Obtaining the Results
Results can be emailed and we will also send hard copies of the report by post.
If the test has been arranged by an individual rather than a clinic, we will send out an invoice with the results.
Payment can be made by cheque, BACS or cash. Bank details for BACS.
Understanding the Results
We recommend that the results are interpreted by doctors specialising in infertility and discussed in detail with their patient. There is an interpretative guide available at this website. It is important that patients should NEVER self-medicate.
Blood test request and consent form
Click here to download the blood test request and consent form for patients.
Please note, for us to process your sample the consent form MUST be signed by both yourself and your doctor.
Download RIC for Patients Leaflet
Download a printer-friendly version of the RIC for Patients leaflet, to read and refer to at your convenience.