Gillian Strachan expected to feel elated when her baby was born: after six miscarriages, Ted’s arrival was the miracle she had been waiting for. But in the aftermath of her caesarean at St Michael’s hospital, Bristol, last year, she was “in shock”.
“Even though I was holding him in my arms I could not believe he was really mine,” she says. “When things have gone wrong so many times you can’t help but wonder whether you are meant to have a baby. Right up to the birth I kept worrying that his heart had stopped. It’s only recently that I have really been able to relax and enjoy having him around.”
Strachan’s reaction was all too understandable. Ted’s birth was the culmination of years of unanswered questions, false hopes and crushing disappointments.
She started trying for a baby in her late thirties. The first miscarriage was upsetting, but not unduly alarming: about 250,000 women in Britain miscarry every year. But when it happened again — and again — Strachan began to question every aspect of her life.
Was it stress? She had a busy career as a television producer and often worked long hours. But that did not make sense. Stress or tiredness might account for one miscarriage, but not six.
Was it her lifestyle? She had hair clippings taken to be analysed for mineral deficiencies and saw a dietician to make sure she was eating properly. Doctors did not seem to be able to help.
A best guess was that she suffered from a blood-clotting disorder that sometimes contributes to miscarriage, but the blood-thinning treatment she was prescribed could not be taken until she was in the sixth week of pregnancy, the point at which she usually lost the baby.
“I was in despair,” says Strachan. “What astonished and angered me was how little we know about miscarriage in this country. Each time, it happened on almost the same day so I knew it had to be something physical. But what?” The answer came by chance. In late 2001 she caught the tail end of a radio report about a doctor in Chicago researching a theory that natural killer (NK) cells — white blood cells that usually protect the body from infection — might play a role in miscarriage.
She tracked down the American doctor and soon afterwards discovered Hassan Shehata, a fertility specialist doing similar work at the Epsom hospital in Surrey and Lister hospital in central London. A simple blood test showed she had a high NK cell count, for which Shehata prescribed steroids.
“I had wasted years and thousands of pounds on other doctors. But he said there was no need to come back, ‘Just send me a picture of your baby’. I could not really believe it would work but within months I had a successful pregnancy,” says Strachan.
Shehata has now submitted a research paper to the journal Human Reproduction, based on 300 women he has treated with steroids to “calm down” the action of NK cells in their bodies. He claims a success rate of more than 80%. If this proves to be correct, his research could help revolutionise not only our understanding of miscarriage but dramatically increase the success of IVF.
The theory that NK cells are the key to the mystery of infertility is controversial: many British doctors are highly sceptical of the idea. When Strachan told a British obstetrician who was treating her that she had contacted Alan Beer, the American pioneer of the anti-NK cell treatment, on the internet and thought he could help, “it was as if I’d said I thought Father Christmas was going to bring me a baby. She was totally dismissive”.
But several research projects are now in train. Annette Quinlan, of Liverpool, gave birth to a girl last year after 19 miscarriages. She, too, was found to have a high NK cell count and was treated with steroids at Liverpool Women’s hospital.
“It’s very exciting,” says Shehata. “Until recently we knew that in some women genetic factors played a part in miscarriage and with others it was sticky blood. But for many, around half, there was no answer. We had to say, ‘Sorry, we don’t know how to treat you’.”
During pregnancy, a woman’s body carries and nurtures a “foreign” body that would normally be selected for destruction by the immune system. The baby may even have a different blood type, but somehow the immune system is modified to allow the baby to grow.
The speculation is that in women who constantly miscarry the immune system does not modify, but attacks. Shehata has identified two kinds of white blood cells, which would usually fight off viruses and bacteria (or be involved in rejecting, say, a kidney transplant), which he believes to be the culprit.
If correct, the theory has huge implications, not just for women who miscarry, but those who are supposedly infertile. It may be that some women who think they cannot get pregnant actually do conceive, but the body rejects the embryo so fast they never even manage a positive pregnancy test.
NK cells would, logically, also play a role in rejecting embryos introduced through IVF treatment, perhaps accounting for its high failure rate — some 80% of IVF cycles fail to produce a viable pregnancy. If, as Shehata contends, it would be possible to treat many of them, like miscarriage patients, with a simple £15 worth of steroids, it could mean many women avoid the misery of painful, drawn-out fertility treatments that cost thousands of pounds.
“It is terrible to see the anxiety of women who have had four or five miscarriages and been messed around for years,” says Shehata. “I believe we can really do something to help them. To see someone with a baby they have longed for is very rewarding.”
For Strachan, it has simply been a miracle: “I still can’t believe my luck.”
Additional reporting: Helena Frith Powell
