IRE Test
Identify causes and treat them in a targeted manner
Sometimes, fertility treatment remains unsuccessful despite optimal conditions, or a pregnancy does not develop properly and results in a miscarriage.
The causes of this can lie in the embryo itself or, among other things, in the uterine lining (endometrium), the place where the embryo is supposed to implant and develop undisturbed, protected from the maternal immune system.
Identify and treat implantation disorders
The uterine lining is immunologically highly specialized to selectively allow the foreign embryo to implant (receptive), but to ward off bacteria, for example (defensive). Sometimes this does not work optimally and implantation disorders occur. The vital embryo implants in the receptive endometrium with a high chance of an ongoing pregnancy.
Implantation disorders can occur in the defensive endometrium, which in particularly severe cases can lead to a miscarriage. The limited vital embryo does not implant under defensive conditions in the endometrium.
In the highly receptive endometrium, endometrial selection is less effective, implantation takes place but an abortion can be the result. But normal, ongoing pregnancies are also possible: every embryo, even the “bad” one, has its chance (see Fig. Embryo-maternal dialogue).
We and our selected partners from pathology and laboratory medicine have been intensively involved with these connections for a long time. According to our experience and the scientific literature, further investigations are recommended if an implantation disorder is suspected, in particular killer cell receptor typing and the immunohistochemical receptivity test of the endometrium, in order to increase the chances of less vital embryos through suitable measures.
To protect the uterine lining, we always try to avoid a curettage in the event of an early miscarriage and therefore prefer to perform a medical termination of pregnancy on an outpatient basis with mifepristone and misoprostol under ultrasound and hormone monitoring.
We are happy to offer our expertise on these and other helpful examinations and finally the discussion of the results and therapeutic options.
The therapeutic spectrum includes, among other things, the administration of a suitable antibiotic, the low-dose administration of cortisone, aspirin, heparin and finally the administration of the growth factor G-CSF. Often the measures are combined with an optimization of the vaginal and endometrial microbiome (including lactobacilli).
Analysis of the uterine lining for the diagnosis of implantation disorders
Extended diagnostics for unfulfilled desire to have children, especially after repeated miscarriages or unsuccessful IVF therapy cycles, includes examination of the uterine lining as an important immunological organ.
For this purpose, the uterine lining is first built up with estradiol and later transformed with a progestogen in order to be able to take a tissue sample from the uterine lining in a hormone-phase-appropriate and precisely datable manner (to the optimum of a presumed implantation). A thin catheter is used to remove an amount of mucous membrane about the size of a lentil to a maximum of a pea from the uterine cavity as part of a gynecological examination and examined using fine tissue analysis.
The fine tissue examination results are compared with ultrasound findings and blood results and it is checked whether the architecture and fine tissue remodeling of the uterine lining has taken place in accordance with the cycle phase. Particular attention is paid to the colonization with different immune cells, because about every 3rd cell in the uterine lining in the 2nd half of the cycle is an immune cell; if necessary, it is also examined whether the uterine lining cells divide accordingly (mitosis index) and also form hormone receptors (estrogen and progesterone receptors) in accordance with the cycle phase.
From these results, important conclusions can be drawn about the receptivity (readiness for conception) of the uterine lining and, if necessary, corresponding therapies can be indicated in connection with further examinations (KIR typing, autoimmune screening, coagulation diagnostics, chromosome analysis).
Occasionally, this uterine lining removal is performed together with an ultrasound contrast agent examination to visualize the uterus, ovaries and fallopian tubes with verification of patency. The removal of the uterine lining sample for the purpose of immunohistochemical examination in the programmed cycle is not a service of the statutory health insurance.
The fine tissue examinations are also only partially covered by the statutory health insurance companies. For patients with statutory health insurance, a co-payment of approx. €150-300 may be incurred. For privately insured patients, the insurance usually, but not always, covers all services.
Extended screening in addition to the IRE test
Killer Cell Receptor Typing (Blood Test)
The uterine killer cells shield the semi-foreign embryo from the maternal immune system and produce important growth factors. There are activating or inhibiting receptors on the uterine killer cells, which significantly influence the killer cell function and the implantation process.
Autoimmune Screening (Blood Test)
Autoantibodies against the body’s own tissue can be associated with an increased risk of miscarriage. An example of this is the so-called anti-phospholipid syndrome (APS), in which the immune system mistakenly forms antibodies against phospholipids, which can lead to an increased tendency to miscarriages.
Coagulation Diagnostics (Blood Test)
Another important component of the diagnostics is the exclusion of a tendency to thrombosis, which is a possible cause of placental dysfunction. A disturbed blood coagulation can impair the supply of the embryo and lead to miscarriages or growth disorders. Therefore, this possibility is checked by means of targeted blood tests.
HyCoSy (Ultrasound Contrast Agent Examination)
An ultrasound contrast agent examination (HyCoSy) is performed to visualize the uterus, ovaries and fallopian tubes and to check the patency of the fallopian tubes. This examination helps to rule out anatomical causes of implantation disorders, such as blocked fallopian tubes or structural abnormalities in the uterus that could impair the natural reproductive process.
Hysteroscopy (Outpatient Surgery with or without Anesthesia)
Hysteroscopy is an outpatient examination in which the uterus is viewed directly with the aid of a thin, flexible instrument, the hysteroscope. It can be performed with or without anesthesia and is used to clarify anatomical problems such as uterine malformations, myomas, polyps or adhesions, which can be possible causes of implantation disorders or repeated miscarriages.
Chromosome Analysis of both Partners (Blood Test)
The chromosome analysis of both partners, a blood test, serves to exclude genetic abnormalities that could be inherited to the offspring. Certain genetic changes can increase the risk of miscarriage or lead to fertility problems. By analyzing the chromosomes of both partners, possible genetic causes for repeated miscarriages or unfulfilled desire to have children can be identified.