Immunomodulation for unexplained recurrent implantation failure: where are we now?

被引:15
作者
Genest, Genevieve [1 ]
Banjar, Shorooq [1 ]
Almasri, Walaa [1 ]
Beauchamp, Coralie [2 ]
Benoit, Joanne [2 ]
Buckett, William [3 ]
Dzineku, Frederick [4 ]
Gold, Phil [1 ]
Dahan, Michael H. [5 ]
Jamal, Wael [2 ]
Kadoch, Isaac Jacques [2 ]
Kadour-Peero, Einav [6 ]
Lapensee, Louise [2 ]
Miron, Pierre [7 ]
Shaulov, Talya [5 ]
Sylvestre, Camille [8 ]
Tulandi, Togas [5 ]
Mazer, Bruce D. [9 ]
Laskin, Carl A. [10 ,11 ]
Mahutte, Neal
机构
[1] McGill Univ, Dept Allergy & Immunol, Montreal, PQ, Canada
[2] Univ Montreal, Dept Gynaecol, Montreal, PQ, Canada
[3] McGill Univ Hlth Ctr Reprod Ctr, Montreal, PQ, Canada
[4] Tripod Med, Toronto, ON, Canada
[5] McGill Univ, McGill Univ Hlth Ctr, Dept Obstet & Gynecol, Montreal, PQ, Canada
[6] McGill Univ, Dept Obstet & Gynecol, Div Reprod Endocrinol & Infertil, Montreal, PQ, Canada
[7] Fertilys Reprod Ctr, Laval, PQ, Canada
[8] Univ Montreal, Div Reprod Endocrinol & Infertil, Montreal, PQ, Canada
[9] McGill Univ, Montreal Childrens Hosp, Dept Pediat, Montreal, PQ, Canada
[10] Univ Toronto, Dept Med, Toronto, ON, Canada
[11] Univ Toronto, Dept Obstet, Toronto, ON, Canada
关键词
IN-VITRO FERTILIZATION; HUMAN CHORIONIC-GONADOTROPIN; LOW-DOSE ASPIRIN; COLONY-STIMULATING FACTOR; MOLECULAR-WEIGHT HEPARIN; LIVE BIRTH-RATES; EMBRYO-TRANSFER CYCLES; REGULATORY T-CELLS; FERTILIZATION/INTRACYTOPLASMIC SPERM INJECTION; INTRAVENOUS IMMUNOGLOBULIN TREATMENT;
D O I
10.1530/REP-22-0150
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
In brief: Immune dysfunction may contribute to or cause recurrent implantation failure. This article summarizes normal and pathologic immune responses at implantation and critically appraises currently used immunomodulatory therapies. Recurrent implantation failure (RIF) may be defined as the absence of pregnancy despite the transfer of >= 3 good-quality blastocysts and is unexplained in up to 50% of cases. There are currently no effective treatments for patients with unexplained RIF. Since the maternal immune system is intricately involved in mediating endometrial receptivity and embryo implantation, both insufficient and excessive endometrial inflammatory responses during the window of implantation are proposed to lead to implantation failure. Recent strategies to improve conception rates in RIF patients have focused on modulating maternal immune responses at implantation, through either promoting or suppressing inflammation. Unfortunately, there are no validated, readily available diagnostic tests to confirm immune-mediated RIF. As such, immune therapies are often started empirically without robust evidence as to their efficacy. Like other chronic diseases, patient selection for immunomodulatory therapy is crucial, and personalized medicine for RIF patients is emerging. As the literature on the subject is heterogenous and rapidly evolving, we aim to summarize the potential efficacy, mechanisms of actions and side effects of select therapies for the practicing clinician.
引用
收藏
页码:R39 / R60
页数:22
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