The Bondi Protocol

Innovative IVF treatment

The Bondi Protocol is an innovative treatment developed by Dr Gavin Sacks based on his research into immune causes of recurrent miscarriage and repeated IVF failure.

Most cases of miscarriage and IVF failure relate to problems with the embryo that occur at random. In cases of repeated miscarriage or IVF failure, testing may reveal issues with the male or female partner’s genetics, the mother’s uterus, hormones, antibody or clotting systems, or the father’s sperm quality.

However, sometimes these tests come back normal. In these cases, further testing of the mother’s immune system may reveal a potential issue affecting her ability to achieve a successful pregnancy.

A photo of a clear fluid-filled circle with a needle inserted through the centre of it. This appears to be an image taken from under a microscope.

Natural killer cells and pregnancy

One of the main functions of the immune system is to identify and remove ‘foreign’ cells from the body. A ‘foreign’ cell is any cell that doesn’t match the person’s genetics, including viruses, bacterial cells and cancer cells.

However, an embryo is also a source of ‘foreign’ cells – half of the embryo’s cells match the father’s genetic material, not the mother’s. So, a successful pregnancy requires the mother’s immune system to not reject the embryo even though it contains ‘foreign’ cells.

Natural killer (NK) cells are a vital part of the immune system, helping the body to recognise and defend against infections and abnormal cells. In pregnancy, however, NK cells in the uterus play a different role – establishing a healthy environment to support a growing foetus.

At the very beginning of a pregnancy, when the embryo implants in the wall of the uterus, NK cells are the most common type of immune cell present inside the uterus. However, if they are too active or their numbers are too high, this could indicate a problem with the immune system that may prevent implantation of the fertilised egg.

A pioneer in reproductive immunology, Dr Sacks has been instrumental in introducing NK cell testing to Australia. NK cell numbers and activity can now be checked through a simple blood test.

“In fact, research has found that high numbers of activated NK cell levels are present in 15–25% of women experiencing repeated IVF failure or recurrent miscarriage.”

Treating the immune system with The Bondi Protocol

The Bondi Protocol is an immune therapy that may suppress the overactive immune system in women with high NK cell activity.

The treatment involves a combination of two common and inexpensive medications: prednisolone and Clexane. It is taken daily by injection, starting at the beginning of an IVF cycle, or as soon as a pregnancy is confirmed, and is continued until at least the 12th week of pregnancy.

“A recent study conducted by Dr Sacks found that for women with high NK cell activity levels, live birth rates were over four times higher when the Bondi protocol was used (28%), compared with standard protocols.1”

Both prednisolone and Clexane are commonly used in early pregnancy and have an established safety profile. However, it is important that women taking The Bondi Protocol are closely monitored by a fertility specialist.

Women on this treatment may experience some minor side effects, including poor sleep, increased fluid retention, and mild pain during injection. The only potential side effect for the baby is a less than 0.5% chance of having a cleft palate (around 3 in 1,000 babies).

If you are experiencing recurrent miscarriage or repeated IVF failure and would like to consult Dr Sacks, click below to book an appointment.

References

  1. Sacks G & Zhang J. Prednisolone and enoxaparin (clexane) therapy (‘the Bondi protocol’) for repeated IVF failure. Am J Reprod Immunol. 2022;88(5):e13616. doi: 10.1111/aji.13616. ↩︎