HELPING GUIDE THE PATH TO PARENTHOOD

Activated Partial Thromboplastin Time (APTT) is a useful and effective method for screening patients with a bleeding tendency and has been widely used as a test for monitoring and regulating heparin therapy.

All individuals with a history of a bleeding disorder, arterial or venous thrombosis, two or more consecutive pregnancy losses or who are receiving anticoagulant therapy should be tested for APTT.

Specimen Requirement:
Collect one (1) blue top tube. Ship at room temperature overnight, next day morning

Presence of autoantibodies to nuclear antigens have been implicated in a number of autoimmune diseases including recurrent pregnancy loss, unexplained infertility or endometriosis. Detection of antinuclear antibodies is helpful in identifying individuals at risk for systemic lupus erythematosus, collagen vascular disease and reproductive autoimmune failure syndrome.

Specimen Requirements:
Collect one (1) 10 ml red or tiger top tube. Ship at room temperature overnight, next day morning

Antiphospholipid Antibodies (APA) are a group of organ nonspecific autoantibodies that bind to both anionic and zwitterionic phospholipids. Their presence has been associated with reproductive failure characterized clinically as recurrent pregnancy loss, unexplained infertility and infertility associated with endometriosis. 
The most consistently reported is the association between recurrent pregnancy loss and the presence of APA; and treatment of APA positive women with heparin or prednisone and aspirin or intravenous immunoglobulin improves pregnancy outcome among these women .

Specimen Requirements:
Collect one (1) 10 ml red or tiger top tube. Ship at room temperature overnight, next day morning

Thyroid autoantibodies have been shown to be independent markers for pregnancies at risk for loss. Women who have antithyroid antibodies miscarry at approximately twice the rate of women who have no antithyroid antibodies. Individual levels of thyroglobulin and thyroid microsomal antibodies are similarly related to the increased miscarriage rate with no evidence of autoantibody specificity.

Approximately 30% of women experiencing recurrent pregnancy loss have one or both antithyroid antibodies. Antithyroid antibodies have also been associated with implantation failure after in vitro fertilization and embryo transfer.

Specimen Requirement:
Collect one (1) 10 ml red or tiger top tube. Ship at room temperature overnight, next day morning

Recurrent pregnancy loss and unexplained infertility may have circulating embryotoxins associated with their reproductive failure. The prevalence of embryotoxic activity among these couples is about 10% to 15%.

Specimen Requirements:
Collect one (1) 10 ml red or tiger top tube. Ship at room temperature overnight, next day morning

Patients with autoimmune diseases characteristically exhibit significant abnormalities in total immunoglobulin isotypes. A very high incidence of such gammopathies is also seen in women experiencing endometriosis, recurrent pregnancy loss, infertility and failure of implantation after in vitro fertilization. The occurrence of hypergammaglobulinemias has been reported to decrease the clinical pregnancy rate with IVF. Hypogammaglobulinemia of IgA needs to be further evaluated to rule out IgA antibodies before treatment with intravenous immunoglobulin is considered.

Specimen Requirements:
Collect one (1) 10 ml red or tiger top tube. Ships room temperature overnight, next day morning

The crossmatch test is an in vitro test to determine the presence of anti-lymphocyte antibody to donor cell antigens (lymphocytotoxic antibody) in serum of an individual with preformed antibodies to donor cells. Examples are recipients for an organ transplant or a couple with a history of recurrent spontaneous abortions. The recipient serum is incubated with donor lymphocytes and the binding can be detected by flow cytometric analysis (with fluorescent conjugated reagent). If cytotoxic antibodies are present in maternal serum, they will combine with surface antigens of donor lymphocytes. This complex is detected by fluorescent anti-human immunoglobulin. The amount of fluorescence on the cells (percentage of positive T or B cells) is proportional to the amount of antibody (flow cytometry crossmatch).

Specimen Requirements:
Collect one (1) 10 ml red or tiger top tube from patient and two (2) green top tubes from husband. Ship at room temperature overnight, next day morning

Lupus-like Anticoagulant (LAC) has been linked to a variety of clinical findings, including recurrent pregnancy loss. LAC is an antiphospholipid antibody directed against negatively charged phospholipids that is identified functionally by prolongation of in vitro phospholipid-dependent coagulation tests such as Activated Partial Thromboplastin Time (APTT),

The prevalence of LAC in patients with a history of recurrent pregnancy loss varies between 1 to 5% depending on the population studies. Among pregnancies in which no treatment is given, 86% are complicated by embryonic or fetal loss.

Specimen Requirements:
Collect plasma from a one (1) blue top tube. Ship at room temperature overnight, next day morning

Natural Killer (NK) cells are a lymphocyte subset that express CD56+ on their cell surface. They are large granular lymphocytes that arise from the bone marrow and circulate peripherally before localizing to specific tissues. NK cells are the most prevalent lymphocyte population in secretory endometrium and in decidua of early pregnancy. They are believed to play a role in regulating trophoblastic cell migration.

The NK cell activation assay tests the killing function of circulating NK cells as well as the ability of intravenous immunoglobulin (IVIg) and intralipid to suppress that activity. NK activity can be measured as a bioassay that determines the ability of activated NK cells to kill their target (K562 cell line). Increased peripheral and endometrial NK killing activity has been demonstrated among patients who experienced spontaneous pregnancy loss or IVF failure.

Specimen Requirements:
Collect one (1) green top tube. Ship at room temperature overnight, next day morning

The Prothrombin Time (PT) Assay measures the time to convert fibrinogen to fibrin by the action of thrombin. The PT assay is sensitive to deficiencies in Factors II, V, VII and X. It can be prolonged by hereditary coagulation disorders, liver disease, vitamin K deficiency and oral anticoagulant therapy. Individuals with a history of bleeding disorders or liver disease and those taking oral anticoagulation therapy should be tested with PT

Specimen Requirements:
Collect one (1) blue top tube. Ships overnight, next day morning.

Identification of the relative concentrations of various blue blood cell populations in blood is valuable in determining risk factors for pregnancy loss. Evaluation of circulating percentage of CD56+ cells has been shown to be associated with reproductive failure. An elevated ratio of CD4+/CD8+ cells is seen in a number of autoimmune disorders including reproductive autoimmune failure syndrome. Detection of elevation of circulating CD56+ cell is helpful in identifying individuals at risk for not implanting embryos and for losing a karyotypically normal pregnancy.

Specimen Requirements:
Collect one (1) green (EDTA) top tube or lavender top tube. Ship at room temperature overnight, next day morning