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Reproductive immunology - the evidence-based version, not the marketing.

Assessment and treatment of immune contributors to recurrent miscarriage and repeated IVF failure - antiphospholipid syndrome, thrombophilias, thyroid antibodies and, where appropriate, NK cell testing. Grounded in RCOG and ESHRE guidance, not hopeful add-ons.

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Indicative pricing

What private reproductive immunology costs in the UK.

Indicative ranges across our reproductive medicine network.

In short

RCOG-guided recurrent miscarriage screen: £950–£1,600, results back in 2–4 weeks.

ProcedureIndicative range
Reproductive medicine consultation £350–£550
RCOG-guided recurrent miscarriage screen £950–£1,600
Antiphospholipid antibody panel (with 12-week repeat) £220–£380
Peripheral blood NK cell panel £320–£520
Uterine NK cell biopsy (timed endometrial) £850–£1,400
Immunology treatment cycle package (aspirin, LMWH, monitoring) £1,200–£2,600
Joint reproductive medicine + haematology MDT £450–£750

Prices vary by consultant, by the workup scope and by whether contested tests are included. Firm quotes always separate proven from empirical treatment, so you can decide with the numbers in front of you.

The problem

The right tests, the right treatments - nothing more, nothing less.

Reproductive immunology is where good private medicine and expensive marketing sit uncomfortably close. A properly run service tests only what will change management and treats only where the evidence supports it.

  • Guideline-first workup

    RCOG and ESHRE guidance drive the initial panel - antiphospholipid, thyroid, karyotype, cavity.

  • Shared decision on the rest

    NK cell testing, intralipid and steroid regimens sit outside guidance. We are honest about the evidence - and the cost.

  • Handover, not indefinite treatment

    By 12 weeks the pregnancy moves into standard antenatal care. Immunology treatment continues on protocol, not on subscription.

The journey

From first review to handover to obstetrics - what happens, in order.

One reproductive medicine consultant sees you from workup through treatment cycle and early pregnancy handover.

  1. 01

    Before

    Number and timing of losses or failed transfers, previous investigations, current medications, thyroid and clotting history, autoimmune disease in the family.

  2. 02

    Before

  3. 03

    Before

    Structured recurrent-loss workup

    Parental karyotype, antiphospholipid antibodies (twice, 12 weeks apart), TSH and thyroid antibodies, pelvic ultrasound, saline sonohysterogram or hysteroscopy for the uterine cavity.

  4. 04

    Before

    Immunology-specific tests where indicated

    Peripheral blood NK cell percentage and cytotoxicity, uterine NK counts on timed biopsy, cytokine panels - offered only where the shared-decision conversation supports them.

  5. 05

    On the day

    Treatment plan review

    A joint reproductive medicine and haematology or rheumatology review. Evidence-based treatment plan agreed and prescribed.

  6. 06

    On the day

    Cycle or pregnancy monitoring

    Aspirin from ovulation, low molecular weight heparin from positive pregnancy test in antiphospholipid syndrome, early scans at 6–8 weeks, close endocrine monitoring.

  7. 07

    After

    Handover to obstetrics

    By 12 weeks, a full obstetric plan is in place with a consultant-led team. Immunology treatment continues per protocol; the pregnancy moves into standard antenatal care with clear ownership.

Typical end-to-end: 6–10 weeks from first appointment to treatment plan. Handover to obstetrics at 12 weeks of a successful pregnancy.

When it helps

When reproductive immunology assessment is the right step.

Presentations where the workup earns its place, plus the pregnancy red flag that means A&E today.

  • Recurrent miscarriage (three or more)

    RCOG defines this as three or more consecutive first-trimester losses. Antiphospholipid syndrome, thyroid disease and uterine anomalies are the treatable causes.

  • Two or more second-trimester losses

    A different pathway - cervical, infective and thrombophilic causes come to the front. Consultant obstetric input is central.

  • Repeated IVF implantation failure

    Three or more failed transfers of good-quality embryos. Endometrial receptivity, uterine cavity and - for a minority - immunology deserve review.

  • Confirmed antiphospholipid syndrome

    Lupus anticoagulant, anticardiolipin or anti-β2-glycoprotein I on two samples 12 weeks apart, with a clinical event. Aspirin and heparin have the best evidence for live-birth improvement.

  • Thyroid autoimmunity

    Anti-TPO antibodies with overt or subclinical hypothyroidism. Levothyroxine to a TSH under 2.5 mIU/L is standard in fertility care.

  • Inherited thrombophilia in selected cases

    Factor V Leiden, prothrombin gene, protein C or S deficiency, especially with a family or personal history of thrombosis. Managed jointly with haematology.

  • Coeliac and other autoimmune disease

    Untreated coeliac is associated with recurrent loss. TTG antibodies and, where positive, gluten-free diet before conception.

  • Red flag: current pregnancy with bleeding and pain

    Any pregnancy bleeding with pain or shoulder-tip discomfort is an ectopic until proven otherwise - A&E early pregnancy unit today, not a fertility clinic.

Procedure options

Every test - and every treatment - with the evidence next to it.

The full menu, sorted by strength of evidence, so you can decide with the trial data in front of you.

  • Antiphospholipid antibody testing

    Lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I antibodies. Repeated at 12 weeks to confirm - a single positive result does not diagnose antiphospholipid syndrome.

  • Thyroid function and antibodies

    TSH, free T4 and anti-TPO antibodies. Treatable, cheap and directly linked to miscarriage risk when abnormal.

  • Parental karyotype

    A balanced translocation in either partner is found in 3–5% of recurrent miscarriage couples - worth testing once.

  • Uterine cavity assessment

    Saline sonohysterogram or hysteroscopy for polyps, submucous fibroids, septum and adhesions. Genuinely structural, not immune, but part of the same workup.

  • Peripheral blood NK cell testing

    Percentage of NK cells in peripheral blood, sometimes with cytotoxicity assays. Interpretation is contested - offered only within an honest shared-decision conversation.

  • Uterine NK cell biopsy

    A timed endometrial biopsy for CD56+ uterine NK cells. Even more contested than peripheral testing; not part of RCOG guidance.

  • Chronic endometritis screen

    CD138 staining on endometrial biopsy for plasma cells. Where positive, a short course of antibiotics is prescribed - a genuinely emerging area.

  • Empirical immune therapies

    Intralipid infusions, intravenous immunoglobulin and steroid regimens - used in some clinics for repeated implantation failure. Evidence is limited; used only within a fully informed shared decision.

Safety and recovery

How to weigh testing and treatment, honestly.

Reproductive immunology done well is one of the best investments a couple with recurrent loss can make. Done badly, it is expensive false hope. Judging which is which is what we help with.

  • Testing is not treatment

    A long panel of antibody tests does not, by itself, help anyone become pregnant.

  • Aspirin and LMWH - the proven pair

    For confirmed antiphospholipid syndrome, low-dose aspirin from ovulation plus LMWH from positive pregnancy test improves live-birth rate by around 40 percentage points in trial data.

  • Bleeding risks of LMWH

    Injection-site bruising is common; serious bleeding is rare. Anaesthetic implications for delivery - planned discussion with obstetric team.

  • Steroids and IVIG side-effects

    Where used in an informed shared decision: weight gain, mood change, glucose intolerance, infection risk (steroids); infusion reactions, thrombosis risk (IVIG). Real costs of unproven benefit.

  • Intralipid infusions

    Marketed for NK cell suppression. Trial evidence is inconsistent. Offered only where the shared-decision conversation is honest about that.

  • Thyroid over-treatment

    Aggressive levothyroxine in euthyroid TPO-positive women has not been shown to improve outcomes and can cause atrial fibrillation and bone loss.

  • Psychological support matters

    Recurrent loss and repeated failed IVF are among the most difficult experiences we see. Psychology is part of a proper service, not an add-on.

  • Do not stop treatment abruptly

    Aspirin, heparin, thyroid replacement and steroids are stopped on a plan with the consultant - never on your own initiative.

  • Red flags in early pregnancy

    Heavy bleeding, severe abdominal pain, shoulder-tip pain, faintness - early pregnancy unit or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever tests were done, the summary the consultant sends you keeps to the same shape.

A UK reproductive medicine consultant reviewing a recurrent miscarriage workup

A quiet reminder

Medical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the results and the evidence before your review, just ask.

  1. 01Header

    Diagnosis and treatment plan

    The specific diagnosis reached (antiphospholipid syndrome, autoimmune thyroid disease, inherited thrombophilia, no immune cause) and the corresponding medication plan.

  2. 02Technique

    Evidence summary

    A short summary of the evidence base for each element of the plan - high (aspirin + LMWH in APS), moderate (levothyroxine in overt hypothyroidism), low (empirical steroids or intralipid).

  3. 03Findings

    What was tested and why

    The tests performed, the results, and - importantly - the tests we chose not to do and the reasons.

  4. 04Impression

    Cycle and pregnancy plan

    Read this first: when to start aspirin and LMWH, when to scan, when to hand over to obstetrics, and when to review the plan if pregnancy is not achieved.

Recognised by major UK insurers

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Standard recurrent miscarriage workup is often covered under specialist gynaecology.

Frequently asked

Everything we get asked about reproductive immunology.

Quick answers on what to test, what actually works, when to be referred and cost.

  • Is reproductive immunology real or a marketing category?

    It is real - antiphospholipid syndrome, thyroid autoimmunity and coeliac disease genuinely contribute to recurrent miscarriage and repeated IVF failure, and evidence-based treatment measurably improves outcomes. It is also, in parts of the private sector, a marketing category - long panels of NK cell and cytokine tests, followed by expensive intralipid or steroid infusions, without matching evidence. A good reproductive medicine consultant separates the two honestly.

  • When is NK cell testing worthwhile?

    Peripheral and uterine NK cell testing sit outside RCOG guidance for recurrent miscarriage. Some centres offer them within a shared-decision conversation for repeated implantation failure after standard workup, but the interpretation is contested.

  • What treatments actually work in reproductive immunology?

    For confirmed antiphospholipid syndrome, low-dose aspirin from ovulation plus low molecular weight heparin from positive pregnancy test has strong trial evidence for improved live birth rate. Levothyroxine for overt or clinically significant subclinical hypothyroidism. Gluten-free diet for coeliac disease. Empirical intralipid, IVIG and steroids for a normal immune workup have limited or inconsistent evidence and are offered only within informed shared decision.

  • When should I be referred to a reproductive immunologist?

    After three consecutive first-trimester miscarriages, after two consecutive second-trimester losses, or after three failed transfers of good-quality embryos in IVF. A single loss or a single failed transfer does not need this pathway - the great majority of couples go on to a healthy pregnancy without any specific immune intervention.

  • How much does private reproductive immunology cost in the UK?

    A reproductive medicine consultation is £350–£550, the RCOG-guided workup is £950–£1,600, an antiphospholipid antibody panel (with 12-week repeat) is £220–£380, and NK cell testing runs £320–£520 peripheral and £850–£1,400 uterine. Treatment cycle packages including aspirin, LMWH and monitoring are £1,200–£2,600.

  • Is this service available on the NHS?

    Recurrent miscarriage clinics with RCOG-aligned workup are available on the NHS in most regions, and antiphospholipid, thyroid and karyotype testing are standard. The unproven immune therapies (intralipid, IVIG, steroid regimens) are generally not offered on the NHS - which is a reasonable stance given the evidence.

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