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Reproductive Peripheral Immunophenotype (RPI)
This comprehensive blood panel allows us to determine the percentage and relative concentration of different populations of immune cells in the peripheral blood. Percentages and/or concentrations that are not within the normal expected ranges may highlight those patients who are at risk of pregnancy loss and so may subsequently benefit from immunotherapies such as steroids and/or Intralipids or IVIG. Identification of the relative levels of various white blood cell populations in blood is valuable in determining risk factors for pregnancy loss. It has become desirable in recent years to identify and characterise these cells in the peripheral blood of selected patients with subfertility to aid understanding of individual circumstances and patient treatment. There is increasing evidence for example, that elevated proportions and activation of NK cells contributes to spontaneous abortion and recurrent pregnancy loss, while our own investigations looking at over 1,500 samples points to low CD8 levels and elevated B-Cells as key actors in this complicated interplay of tolerance and cellular responses to pregnancy
Reproductive Uterine Immunophenotype (RUI)
The "Reproductive Uterine Immunophenotype" (RUI) test analyses an endometrial biopsy to assess the uterine immune micro-environment, which can play a role in infertility by creating a "hostile uterus" that prevents pregnancy or causes miscarriage The RUI test identifies and characterizes the various immune cells present in the endometrium, a process known as immune cell heterogeneity. This is accomplished by analysing the cells using a technique called flow cytometry. Here are some key aspects of the RUI test and how it works: • Immune Cell Markers: The test focuses on identifying immune cells, primarily lymphocytes, by analyzing specific markers on their surface. These markers include uNK, pNK, NK-T (with subsets CD56 bright, CD56 dim and CD57+), CD19, CD3, CD5, CD8, and CD4 with subsets; Th1, Th2, Th17, Treg3. • Timing of Biopsy: The test requires an endometrial biopsy taken during the mid-secretory phase of the menstrual cycle, specifically between cycle days 18 to 24. This timing is crucial as the immune environment of the endometrium changes throughout the menstrual cycle. • Additional Markers: While not fully validated, the test also examines the presence of CD14, which helps differentiate monocytes from lymphocytes, and CD138, a marker for plasma cells, which could indicate endometritis. • Identifying Subsets: By identifying both the type and activation status of immune cells, the test can distinguish between patients with high and low immune activation in the endometrium. This information can then be used to guide treatment decisions for infertility.
ReproFlow Immune Status Test (RIST)
This comprehensive blood panel allows us to determine the relative percent and concentration of different populations of immune cells in the peripheral blood. It’s like a very deep dive into the full blood count which is the most requested blood test. We look at the key innate and adaptive leukocytes including monocytes, NK, NK-T, B and T cells (including subsets), highlighting those that are not within the normal expected ranges.
Epithelial β3 Integrin (EB3)
The EB3 evaluation is a test that assesses the readiness of the uterus for embryo implantation. It looks for a specific protein (CD61) that indicates the uterus is prepared to accept an embryo. Another marker, CD44, is being studied as well; while it isn't fully validated yet, it may also provide useful information about the uterus's receptivity based on its role in cell movement and growth. Overall, these markers help us understand how well the uterus is preparing for pregnancy and whether more time or progesterone or both needs to be utilised to optimise the window of implantation.