Dr. Carol Gloria talks about APAS and Repro-Immune Disorder

This second installment is from my book, Lost but Found. (Get the book here!) This is an interview of my reproductive immunologist, Dr. Caroline Tolosa-Gloria, answers Frequently Asked Questions on Reproductive Immune Failure (RIF).

Dr. Carol Gloria and her Wall of Hope


Dr. Carol Gloria is also a pediatric allergist and an APAS warrior. She holds clinic at the Asian Hospital and Medical Center. Together with her husband, Dr. CJ Gloria, she helps many couples who are suffering from RIF. 

  1. What is RIF?

Reproductive Immune Failure is the inability of an individual to reproduce after months of actively trying to conceive due to a probable immunologic cause. It includes infertility and repeated pregnancy loss.

  1. What are the different categories of RIF?

Dr. Alan Beer, a world-renowned physician and scientist, spent most of his academic life analyzing the relationship between the immune system and reproductive health. He identified five categories of the immune problem that can cause pregnancy loss, IVF failure, and infertility. 

Category I Immune Problems: Tissue Type Compatibility. This happens when the couple’s tissue is too compatible and the couple’s tissue type is too closely matched. This results to a baby that shares a very similar genetic match to the mother. When this happens, the mother’s immune system could consider the placenta foreign and her immune system becomes activated against the baby’s cells.

Category II Immune problems: Blood clotting defects. The production of antibodies that attack fatty molecules on the surface of a cell called phospholipids has been identified as a cause of miscarriage. APAS (Antiphospholipid Antibody Syndrome) can make the blood clot more easily and may cause blocking of the blood flow to the embryo, which can lead to fetal demise. 

Category III: Immunity to Pregnancy. Antibodies to the DNA components in the embryo or in pregnancy tissue surrounding it are found in women who have reproductive failure. This causes local inflammation causing miscarriages. 

Category IV: Antibodies to sperm. Infertile women often produce their own antibodies to the sperm, thus the sperm does not move and conception cannot be achieved.

Category V: Natural Killer Cells and Antibodies to Hormones and Neurotransmitters. We are born with natural killer cells and other antibodies that defend us against cancer cells and foreign invaders like viruses and bacteria. When these cells increase in number and activity, they cause problems with infertility and miscarriages. 

Category 1 is the least severe and Category 5 is the most severe. Most patients may possess more than one category. They interconnect with one another, thus cascading responses occur, reducing the chances of a successful pregnancy. 

In early 2019, a revision on the Alan Beer book dropped the categorization of the immune failure and just made descriptions of the factors involved. 

  1. What are the causes of reproductive failure? 

There are many causes of reproductive failure: chromosomal abnormalities, abnormal uterine or cervical anatomy, hormonal imbalances, infection and illness, environmental factors, and immune system problems as with RIF.  

  1. What are the symptoms of RIF?

It is manifested as difficult pregnancy which includes but limited to infertility, repeated implantation failure in IVF, and recurrent pregnancy loss.

  1. What do patients need to do when they find out they have RIF?

If you have two or more miscarriages, IVF failure, and unexplained infertility, you would benefit in being evaluated by a reproductive immunologist who will recommend a battery of tests to identify if there may be immune causes to your problem. 

  1. What are the possible treatments?

Treatments are geared towards what immune problems have been identified after testing. 

  1. You have mentioned about natural immunotherapy in the past. Can you expound on this? 

This area of medicine is controversial. Immunotherapy provides a temporary state of balance during the early part of pregnancy and in some cases, all throughout pregnancy. Natural immunotherapy assists this treatment with good nutrition and holistic therapy, bringing about optimal health. Healthy living is the way to go.