One of the biggest controversies in reproductive medicine: natural killer cells
Leigh Travers and her partner Matt endured a six-year long struggle of seven heartbreaking miscarriages and $25,000 in IVF treatment before the successful birth of their daughter Ava.
Ms Travers believes they owe Ava's birth to the treatment for arguably the most controversial cells in reproductive medicine: natural killer cells (NK cells).
NK cells are part of the normal immune system and are responsible for cleaning up abnormal cells in our bodies, such as early cancer.
The contentious question is whether high levels of NKC contribute to infertility or increase the risk of miscarriage.
Doctor Gavin Sacks was the fertility specialist who recommended Ms Travers for an experimental treatment he developed, called Bondi Protocol.
"By lowering the body's immune response through the Bondi Protocol, we are trying to stop the natural killer cells from attacking the embryo in the womb because they see it as a foreign body," Dr Sacks explained on the IVF Australia website.
A blood test measures the number and activation levels of NK cells, and the treatment includes an immunosuppressant (such as steroids).
Dr Sacks has tested the Bondi Protocol on 87 women who had a poor prognosis; 56 had been trying for a baby for years with continued IVF failure, while the other 31 women had experienced recurrent miscarriage.
"For the women in the recurrent miscarriage group, 80 per cent became pregnant within a year naturally [after the treatment]. In the repeated IVF failure group, 68 per cent fell pregnant within three cycles of IVF," he wrote.
"The live birth rate in women under 38, with clinical history of no reproductive issues, was 86 per cent, which is very promising."
Researchers from the UK also found a link between NK cells and recurrent miscarriage.
However, Associate Professor Mark Bowman, from the Fertility Society of Australia, said there is yet to be a randomised controlled trial to confirm that the Bondi Protocol works, adding that "it's disappointing that no one has tried harder to make that trial happen".
He admitted that "for a small proportion of women who have had repeated miscarriage we think some of them have an altered immune response [which the Bondi Protocol targets], that makes it harder for them to remain pregnant".
But in addition to the lack of proper trials, he says it is difficult to determine how valid the NK cell tests are, and whether people are truly benefiting from the treatment.
"It might be reasonable for an doctor to say to their patient 'this treatment is not proven, but I've had some personal experience and if you want to try it you can', but it would just be important for that person to make a proper informed consent discussion," Prof Bowman said.
Doctor David Wilkinson, the medical director at City Fertility Melbourne, said doctors should try to provide a balanced perspective, but to not discount the treatment for the lack of evidence because "it's very difficult to always offer things that have absolutely been proven".
"There are a couple of doctors who are very strong believers in the NK cells … and others are not, but have some patients who are having a terrible time, and will do anything if they think it might increase their chances," Dr Wilkinson said.
"And you'll think 'well if something isn't dangerous, and everything else has been tried, and the patient wants to try it, then we'll go along with that'".
What's devastating for Ms Travers is that she was given this choice "too late", only receiving the Bondi Protocol treatment after seven failed pregnancies.
She remained on it for 16 weeks and had her healthy daughter Ava naturally in July 2013.
Sara La Cava also had repeated IVF failure following years of infertility.
On her fifth attempt of IVF and after eight months on NK cells treatment, she gave birth to healthy twins Alexander and Antonio in April last year.
"I wish that the natural killer cell testing would've happened sooner ... it could have been a quicker path to having children, and there aren't a lot of people who know about it," Mrs Cava said.
If doctors at least gave couples the option to have the testing earlier, rather that "not even mention it", Ms Travers believes it could avoid much trauma of emotional and financial pressure.
"It makes me mad that IVF clinics are not doing these NK cell tests as routine … we spent $25,000 on IVF and we didn't need it in the end. Even if it's not entirely proven, at least let people know this could be a possibility. I don't want anyone to go through what I went through," Ms Travers said.
Both Prof Bowman and Dr Wilkinson hope more trials will be done to confirm whether NKC treatment is effective, but Ms Travers and Mrs Cava said they have their evidence.
"Seven losses and then an eighth pregnancy on the [NKC] drugs that results in a take-home baby is too much of a coincidence for me," Ms Travers said.
"The proof of the pudding is Ava."Sursa