1
|
Kumar P, Philip CE, Eskandar K, Marron K, Harrity C. Effect of intravenous immunoglobulin therapy in recurrent implantation failure: A Systematic review and meta-analysis. J Reprod Immunol 2024; 166:104323. [PMID: 39241575 DOI: 10.1016/j.jri.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/11/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND IVIg is a pooled donor immunoglobulin preparation, used for auto-immune and inflammatory diseases. In assisted reproduction it receives considerable scepticism. Clinical data is expanding, but individual studies may be perceived as weak, meaning an updated appraisal of evidence in implantation failure is needed. OBJECTIVE To assess the efficacy of IVIg in Recurrent Implantation Failure (RIF) following assisted reproductive technology. DESIGN Systematic review and meta-analysis of randomized controlled trials and observational studies comparing IVIg therapy against placebo in a defined RIF population. MATERIALS AND METHODS A comprehensive literature search, identifying studies involving RIF following ART, using pre-conception IVIg. Primary outcomes were clinical pregnancy (CPR), live birth (LBR), implantation (IR), and miscarriage rates (MR). The selection process yielded twelve studies, including 1023 cases and 2276 controls. RESULTS A significant increase in CPR (OR=5.14, 95 % CI: 2.33-11.30, p<0.001) and LBR (OR=4.60, 95 % CI:2.44-8.68, p<0.001) is demonstrated in IVIG-treated patients, with an improvement in IR (OR=2.35, 95 % CI: 1.04-5.29, p=0.039) and reduction in MR (OR=0.60, 95 % CI: 0.37-0.97, p=0.036). Substantial heterogeneity was identified across studies, which was addressed through subgroup analyses, assessing if the variability in may be attributed to study-specific factors. CONCLUSIONS IVIg may enhance implantation, clinical pregnancy, and live birth rates in RIF patients, underscoring benefit for specific populations. Positive immunological risk factors may predict potential candidates, but it could also be of use in unexplained RIF with high-grade embryos. These findings highlight the importance of personalized therapeutic strategies to improve ART outcomes for complex cases.
Collapse
Affiliation(s)
| | - Chris E Philip
- Beaumont Hospital, Dublin, Ireland; Indiana University School of Medicine, Indianapolis, USA
| | | | | | - Conor Harrity
- Rotunda Hospital, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland; RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| |
Collapse
|
2
|
Khairy M, Harb H, Eapen A, Melo P, Kazem R, Rajkhowa M, Ndukuwe G, Coomarasamy A. The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study. Am J Reprod Immunol 2024; 91:e13819. [PMID: 38348954 DOI: 10.1111/aji.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
PROBLEM Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S) This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.
Collapse
Affiliation(s)
| | - Hoda Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Abey Eapen
- Department of Obstetrics and Gynaecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pedro Melo
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | | | | | | | - Arri Coomarasamy
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| |
Collapse
|
3
|
Silvestris E, Petracca EA, Mongelli M, Arezzo F, Loizzi V, Gaetani M, Nicolì P, Damiani GR, Cormio G. Pregnancy by Oocyte Donation: Reviewing Fetal-Maternal Risks and Complications. Int J Mol Sci 2023; 24:13945. [PMID: 37762248 PMCID: PMC10530596 DOI: 10.3390/ijms241813945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Oocyte donation (OD) has greatly improved over the last three decades, becoming a preferred practice of assisted reproductive technology (ART) for infertile women wishing for motherhood. Through OD, indeed, it has become possible to overcome the physiological limitation due to the ovarian reserve (OR) exhaustion as well as the poor gamete reliability which parallels the increasing age of women. However, despite the great scientific contribution related to the success of OD in the field of infertility, this practice seems to be associated with a higher rate of major risky events during pregnancy as recurrent miscarriage, infections and placental diseases including gestational hypertension, pre-eclampsia and post-partum hemorrhage, as well as several maternal-fetal complications due to gametes manipulation and immune system interaction. Here, we will revisit this questioned topic since a number of studies in the medical literature focus on the successful aspects of the OD procedure in terms of pregnancy rate without, however, neglecting the risks and complications potentially linked to external manipulation or heterologous implantation.
Collapse
Affiliation(s)
- Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
| | - Easter Anna Petracca
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Francesca Arezzo
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Vera Loizzi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
- Department of Precision and Regenerative Medicine—Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Maria Gaetani
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Pierpaolo Nicolì
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
- Department of Precision and Regenerative Medicine—Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
| |
Collapse
|
4
|
Rezayat F, Esmaeil N, Rezaei A, Sherkat R. Contradictory Effect of Lymphocyte Therapy and Prednisolone Therapy on CD3 +CD8 +CD56 + Natural Killer T Population in Women with Recurrent Spontaneous Abortion. J Hum Reprod Sci 2023; 16:246-256. [PMID: 38045499 PMCID: PMC10688285 DOI: 10.4103/jhrs.jhrs_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
Background Natural killer T (NKT) cells are influential immune cells in pregnancy failures, including recurrent spontaneous abortion (RSA). Different approaches are used for these disorders due to their effects on maternal immunomodulation. Aims In the present study, we compared the effects of two typical immunotherapies (lymphocyte immunotherapy [LIT] and low-dose prednisolone) on CD3+CD56+CD16+ and CD3+CD56+CD8+ cells as two distinct subsets of NKT cells in Women with RSA. Settings and Design This study was a comparative cohort study conducted from 2021 to 2022. One hundred and five women with RSA were distributed into three treatment groups randomly. Materials and Methods Fifty women in the group of low-dose prednisolone therapy, fifty women in the LIT group and five women without any treatment as the control group were included in the study. NK and NKT cell subsets were assessed using flow cytometry. Furthermore, the concentration of interferon-gamma (IFN-γ), transforming growth factor-beta (TGF-β) and interleukin-10 (IL-10) was measured quantitatively using the enzyme-linked immunosorbent assay technique. Statistical Analysis Used Normality and comparisons between study groups were performed by non-parametric unpaired Mann-Whitney, Kruskal-Wallis rank sum test, and one-way ANOVA. Results The percentage of CD56dim NK cells was increased after prednisolone therapy, while this population significantly decreased in the LIT group. In contrast to the LIT group, the administration of prednisolone increased CD3+CD8+CD56+ NKT cells (P < 0.0001), which is helpful for pregnancy. The effect of the investigated treatment approaches on the population of peripheral CD3+CD56+CD16+ NKT cells of women with RSA was not adequately significant. The same situation was also observed regarding the serum level of IFN-γ. However, a significant decrease in serum levels of IL-10 and TGF-β was observed after prednisolone therapy. Conclusion The lower capability of LIT in changing the population of NKT cells compared to prednisolone therapy may be due to its mechanism of action, which is related to the production of blocking antibodies. These treatment approaches had different effects on NKT cells, indicating that NKT cell population and function can be affected using LIT and prednisolone therapy distinctly. In addition, prednisolone therapy and LIT in women with normal serum levels of IFN-γ have no harmful effects in changing the production of this critical cytokine.
Collapse
Affiliation(s)
- Fatemeh Rezayat
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Rezaei
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Sherkat
- Immunodeficiency Diseases Research Center, Isfahan, Iran
| |
Collapse
|
5
|
Genest G, Banjar S, Almasri W, Beauchamp C, Benoit J, Buckett W, Dzineku F, Gold P, Dahan MH, Jamal W, Jacques Kadoch I, Kadour-Peero E, Lapensée L, Miron P, Shaulov T, Sylvestre C, Tulandi T, Mazer BD, Laskin CA, Mahutte N. Immunomodulation for unexplained recurrent implantation failure: where are we now? Reproduction 2023; 165:R39-R60. [PMID: 36322478 DOI: 10.1530/rep-22-0150] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022]
Abstract
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. Abstract 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.
Collapse
Affiliation(s)
- Geneviève Genest
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Shorooq Banjar
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Walaa Almasri
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Coralie Beauchamp
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Joanne Benoit
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - William Buckett
- McGill University Health Centre Reproductive Centre, Montreal, Quebec, Canada
| | | | - Phil Gold
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wael Jamal
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | | | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada
| | - Louise Lapensée
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Pierre Miron
- Fertilys Reproductive Center, Laval, Quebec, Canada
| | - Talya Shaulov
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Sylvestre
- Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Quebec, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruce D Mazer
- Department of Pediatrics, McGill University, Division of Allergy Immunology and Clinical Dermatology, Montreal Children's Hospital, McGill University, Montréal, Quebec, Canada
| | - Carl A Laskin
- Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, Toronto, Ontario, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Egerup P, Nielsen HS, Andersen AN, Christiansen OB. Live Birth Rate in Women with Recurrent Pregnancy Loss after In Vitro Fertilization with Concomitant Intravenous Immunoglobulin and Prednisone. J Clin Med 2022; 11:1894. [PMID: 35407500 PMCID: PMC9000183 DOI: 10.3390/jcm11071894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023] Open
Abstract
Pregnancy loss after in vitro fertilization (IVF) is at least as common as after spontaneous conception. Recurrent pregnancy loss (RPL) may often have an immunological background, and it is therefore relevant to test immune-based interventions in these patients. The objective was to investigate the effect of immunotherapy with intravenous immunoglobulin (IvIg) and prednisone (PRS) as concomitant therapy to IVF in women with RPL after earlier IVF treatments. In a cohort study conducted at The Danish RPL Clinic, 41 women with three or more consecutive pregnancy losses after IVF underwent at least one further IVF cycle with concomitant immunotherapy from 2012 to 2017. The immunotherapy with IvIg and PRS was given before embryo transfer and repeatedly in the first trimester when pregnancy was achieved. Fourteen women (34.2%) achieved a live birth after the first embryo transfer with immunotherapy, and a total of 32/41 (78%) achieved a live birth after up to 4 embryo transfers. Baseline characteristics and the presence of autoantibodies were not significantly different among women achieving live birth or not. The observed 34% birth rate in women with RPL after IVF receiving immunotherapy appears higher than the expected 16-19% birth rate without immunotherapy and is similar to findings in a previous cohort from our clinic. Concomitant immunotherapy as described may be a promising intervention for women with RPL after IVF; however, the effect must be tested in a randomized controlled trial.
Collapse
Affiliation(s)
- Pia Egerup
- The Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital and Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (P.E.); (H.S.N.)
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- The Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital and Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (P.E.); (H.S.N.)
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Anders Nyboe Andersen
- The Fertility Department, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Ole Bjarne Christiansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark
| |
Collapse
|
7
|
The impact of IVIG therapy on live birth rates in women with RPL: A systematic review and meta-analysis. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2021.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Ma S, Peng Y, Hu L, Wang X, Xiong Y, Tang Y, Tan J, Gong F. Comparisons of benefits and risks of single embryo transfer versus double embryo transfer: a systematic review and meta-analysis. Reprod Biol Endocrinol 2022; 20:20. [PMID: 35086551 PMCID: PMC8793185 DOI: 10.1186/s12958-022-00899-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence referring to the trade-offs between the benefits and risks of single embryo transfer (SET) versus double embryo transfer (DET) following assisted reproduction technology are insufficient, especially for those women with a defined embryo quality or advanced age. METHODS A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched based on established search strategy from inception through February 2021. Pre-specified primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). Odds ratio (OR) with 95% confidence interval (CI) were pooled by a random-effects model using R version 4.1.0. RESULTS Eighty-five studies (14 randomized controlled trials and 71 observational studies) were eligible. Compared with DET, SET decreased the probability of a live birth (OR = 0.78, 95% CI: 0.71-0.85, P < 0.001, n = 62), and lowered the rate of multiple pregnancy (0.05, 0.04-0.06, P < 0.001, n = 45). In the sub-analyses of age stratification, both the differences of LBR (0.87, 0.54-1.40, P = 0.565, n = 4) and MPR (0.34, 0.06-2.03, P = 0.236, n = 3) between SET and DET groups became insignificant in patients aged ≥40 years. No significant difference in LBR for single GQE versus two embryos of mixed quality [GQE + PQE (non-good quality embryo)] (0.99, 0.77-1.27, P = 0.915, n = 8), nor any difference of MPR in single PQE versus two PQEs (0.23, 0.04-1.49, P = 0.123, n = 6). Moreover, women who conceived through SET were associated with lower risks of poor outcomes, including cesarean section (0.64, 0.43-0.94), antepartum haemorrhage (0.35, 0.15-0.82), preterm birth (0.25, 0.21-0.30), low birth weight (0.20, 0.16-0.25), Apgar1 < 7 rate (0.12, 0.02-0.93) or neonatal intensive care unit admission (0.30, 0.14-0.66) than those following DET. CONCLUSIONS In women aged < 40 years or if any GQE is available, SET should be incorporated into clinical practice. While in the absence of GQEs, DET may be preferable. However, for elderly women aged ≥40 years, current evidence is not enough to recommend an appropriate number of embryo transfer. The findings need to be further confirmed.
Collapse
Affiliation(s)
- Shujuan Ma
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Yangqin Peng
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Liang Hu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Xiaojuan Wang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Yiquan Xiong
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Yi Tang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Jing Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, China.
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China.
| |
Collapse
|
9
|
Reproductive outcomes of women with recurrent pregnancy losses and repeated implantation failures are significantly improved with immunomodulatory treatment. J Reprod Immunol 2021; 148:103369. [PMID: 34492567 DOI: 10.1016/j.jri.2021.103369] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/26/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
This study investigated if immunomodulatory treatment improves the in-vitro fertilization (IVF) success rates of women with two or more recurrent pregnancy losses (RPL) and repeated implantation failures (RIF) with cellular immune abnormalities and thrombophilia. We performed a retrospective cohort study of 197 RPL patients who received immunomodulatory and anticoagulation treatment undergoing IVF cycles (fresh or frozen embryo transfer). Patients were divided into four groups; Group 1: women with RPL but without RIF, Group 2: women with RPL and RIF (≥3), Group 3: women with RPL after IVF cycles (>2) and without RIF, and Group 4: women with RPL after IVF cycles and RIF. Patients received immunomodulatory treatment with prednisone-only or prednisone and intravenous immunoglobulin G (IVIG) and anticoagulation treatment with low molecular weight heparin and low dose aspirin. IVF success rates of study groups were compared to those of the historical controls. The pregnancy rate of IVF cycles with immunomodulatory treatment was significantly increased in all patients (48.2 % vs. 33.0 %, P < 0.001), Group 1 (54.2 % vs. 30.5 %, P < 0.005) and Group 2 (33.3 % vs. 11.0 %, P < 0.005) as compared to historical controls. The live birth rates per ET cycle were significantly improved for all patients (1.8 % vs. 39.6 %, P < 0.001), and study groups compared to their historical controls (Group 1, 43.1 % vs. 0 %; Group 2, 33.3 % vs. 2.5 %; Group 3, 45.5 % vs. 2.3 %; and Group 4, 16.7 % vs. 1.2 %, P < 0.001, respectively). Immunomodulatory and anticoagulation treatment significantly improved the reproductive outcomes of IVF cycles in women with a history of RPL and/or RIF of immune etiologies.
Collapse
|
10
|
Wang Y, Tian Y, Liu L, Li TC, Tong X, Zhu H, Zhang S. The number of previous failed embryo transfer cycles is an independent factor affecting implantation rate in women undergoing IVF/ICSI treatment: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e25034. [PMID: 33655977 PMCID: PMC7939155 DOI: 10.1097/md.0000000000025034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT The implantation rate (IR) in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection is affected by many different factors such as age, quality of embryo, and stage of embryo development. This study aimed to investigate to what extent the number of previous failed embryo transfer cycles is an independent factor affecting IR.This was a single-center, retrospective cohort study of a consecutive series of 6376 day-3 embryo transfer (ET) cycles following IVF between January 2012 and August 2018. None of the subjects underwent endometrial scratch/injury prior to the treatment cycle, or received intravenous immunoglobulin, steroid, dehydroepiandrosterone, intralipid or heparin during the treatment with the aim of improving implantation rates.Multiple regression analysis showed that the 3 most important independent factors affecting the IR, in decreasing of importance: age, frozen or fresh embryo transfer and the number of previous ET cycles. Having controlled for 2 of the more important confounding variables including maternal age and the type of embryo, the IR in women who had 0, 1, 2, and 3 or more previous failed ET cycles were 45.8%, 35.9%, 31.2%, 21.0%, respectively (P < .001).Repeated implantation failure is a significant independent factor affecting the IR. The number of previous failed ET cycles should be considered in counselling women regarding the prognosis of a further IVF-ET treatment cycle.
Collapse
Affiliation(s)
- Yangyang Wang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Yichao Tian
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Liu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaomei Tong
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Haiyan Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| |
Collapse
|
11
|
Is there a Role of Intravenous Immunoglobulin in Immunologic Recurrent Pregnancy Loss? J Immunol Res 2020; 2020:6672865. [PMID: 33426092 PMCID: PMC7781684 DOI: 10.1155/2020/6672865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 01/01/2023] Open
Abstract
Recurrent pregnancy loss (RPL) commonly refers to three or more miscarriages that occur before 20 weeks of pregnancy. The immunological cause of RPL could be either an auto- or alloimmune-related event or both. Because of the discovery of immunological abnormalities in RPL patients in clinical practice, several immunomodulatory therapies were introduced to maintain the immune balance at the maternal-fetal interface. Intravenous immunoglobulin (IVIg) is one of the immunomodulators. In recent years, several studies have analyzed the therapeutic effect of IVIg on RPL patients with antiphospholipid syndrome (APS) or unexplained RPL. However, their results are controversial. IVIg can be used in RPL patients with APS who have previously failed in other treatments. It is recommended that IVIg infusion could be considered used before conception in RPL patients who have cellular immune abnormalities such as increased natural killer (NK) cell counts, NK cell cytotoxicity, or increased T helper (Th)1/Th2 ratio, depending on the cut-off values of each hospital. The aim of this review was to summarize the mechanisms, efficacy, pharmacokinetics, and side effects associated with passive immunization using IVIg in immunologic RPL, according to the literature published in recent years. We hope that more obstetricians will be able to understand the timing and indication of IVIg properly in immunologic RPL patients and effectively enhance pregnancy outcomes for mothers and neonates.
Collapse
|
12
|
Lorzadeh N, Kazemirad N. The Role of Natural Killer Cells and Mast Cells in Female Infertility and Associated Treatment Outcomes. CURRENT WOMEN S HEALTH REVIEWS 2020. [DOI: 10.2174/1573404816666200206111550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
One of the identified causes of infertility has been related to the inability
to regulate immunological tolerance of the maternal immune system against the developing fetus,
thereby inhibiting the process of implantation. Various immune cells have been identified to contribute
to the concept of un-regulated immunological tolerance, such as mast cells (MCs) and natural
killer cells (NK). There are available evidences that MC play a role in the pathogenesis of infertility
diseases like endometriosis and NK in specific infertility disease.
Objective:
Presently, there are studies to formulate and develop immunosuppressive drugs in order
to suppress or inhibit the process of immune rejection caused by maternal immune cells. In addition,
there have been reports regarding the use of steroids for the treatment of miscarriage that can
inhibit the activity of most immune cells.
Conclusion:
This review is to give a comprehensive mini-review on the role of immune cells, especially
mast cells and NK cells in developing novel infertility treatment.
Collapse
Affiliation(s)
- Nahid Lorzadeh
- Department Obstetrics and Gynecology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nastaran Kazemirad
- Student Research Committee, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Abdolmohammadi-Vahid S, Pashazadeh F, Pourmoghaddam Z, Aghebati-Maleki L, Abdollahi-Fard S, Yousefi M. The effectiveness of IVIG therapy in pregnancy and live birth rate of women with recurrent implantation failure (RIF): A systematic review and meta-analysis. J Reprod Immunol 2019; 134-135:28-33. [DOI: 10.1016/j.jri.2019.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/24/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
|
14
|
Gonçalves DR, Braga A, Braga J, Marinho A. Recurrent pregnancy loss and vitamin D: A review of the literature. Am J Reprod Immunol 2018; 80:e13022. [PMID: 30051540 DOI: 10.1111/aji.13022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects approximately 1%-2% of reproductive women. Auto- and cellular immune responses seem to be associated with RPL. Vitamin D (VD) has been shown to play a role in the modulation of the immune system. Effects of VD deficiency (VDD) in pregnancy have been associated with preeclampsia, gestational diabetes, fetal growth restriction, preterm labor, and sporadic spontaneous abortion (SA). We systematically reviewed articles that studied women with 2 or more SA and its association with VD. Eleven studies were included. Studies reported a high prevalence of VD insufficiency (VDI) or VDD in women with RPL and suggested that this could be associated with immunological dysregulation and consequently with RPL. Immunological benefits were reported in the peripheral blood of women with RPL after VD exposure. Thus, it is possible to speculate a beneficial role for VD supplementation in RPL. It seems that there are not differences in the vitamin D receptor (VDR) and CYP27B1 expression in endometrium of women with RPL but, in villous and decidual tissues, RPL women seem to have a decreased expression of VDR and, perhaps, a decreased expression of CYP27B1. Further randomized controlled studies are required to investigate the association between VDD or VDI and RPL.
Collapse
Affiliation(s)
| | - António Braga
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Braga
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - António Marinho
- UMIB, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Clinical Immunology Unit, Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|
15
|
Ali SB, Jeelall Y, Pennell CE, Hart R, McLean-Tooke A, Lucas M. The role of immunological testing and intervention in reproductive medicine: A fertile collaboration? Am J Reprod Immunol 2017; 79. [DOI: 10.1111/aji.12784] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Syed B. Ali
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
| | - Yogesh Jeelall
- School of Medicine and Pharmacology; University of Western Australia; Perth WA Australia
- Harry Perkins Institute of Medical Research; Perth WA Australia
| | - Craig E. Pennell
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
- The Women and Infants Research Foundation; Perth WA Australia
| | - Roger Hart
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
- Fertility Specialists of Western; Bethesda Hospital; Claremont WA Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
- Pathwest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth WA Australia
| | - Michaela Lucas
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
- Pathwest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth WA Australia
- School of Medicine and Pharmacology; School of Pathology and Laboratory Medicine; University of Western Australia; Perth WA Australia
- Institute for Immunology and Infectious Diseases; Murdoch University; Perth WA Australia
| |
Collapse
|
16
|
Fan W, Huang Z, Li S, Xiao Z. The HLA-G 14-bp polymorphism and recurrent implantation failure: a meta-analysis. J Assist Reprod Genet 2017; 34:1559-1565. [PMID: 28707147 DOI: 10.1007/s10815-017-0994-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/28/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The human leucocyte antigen-G (HLA-G) 14-bp insertion/deletion polymorphism was implicated in recurrent implantation failure (RIF), but individual published studies showed inconclusive results. Thus, a meta-analysis was performed to clarify the effect of HLA-G 14-bp polymorphism on RIF risk. METHODS A comprehensive search for relevant articles was conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) for HLA-G 14-bp polymorphism and RIF were calculated. RESULTS A total of five studies were included. In studies conducted in RIF patients and controls who had at least one spontaneous pregnancy, meta-analysis revealed no statistically significant association between the HLA-G 14-bp polymorphism and RIF in allele contrast and all genetic models in the overall population, but significant association was found in the population of Caucasian origin under allele contrast (OR = 1.73, 95% CI, 1.20, 2.50) and genetic models of +14 bp/+14 bp vs. -14 bp/-14 bp (OR = 3.09, 95% CI, 1.43, 6.65). In studies conducted in RIF patients and controls who had successful pregnancy following IVF-ET, the meta-analysis showed that there was statistically significant association between the HLA-G 14 bp polymorphism and RIF in allele contrast (OR = 1.74, 95% CI, 1.13, 2.67) and genetic models of +14 bp/+14 bp vs. -14 bp/-14 bp (OR = 10.20, 95% CI, 2.47, 42.14) and dominant model (OR = 4.34, 95% CI, 1.72, 10.92). No publication bias was found in the present studies. CONCLUSIONS This meta-analysis suggested that the HLA-G 14-bp insertion allele may increase the risk of RIF in Caucasians. Further studies with large sample size of different ethnic populations are necessary.
Collapse
Affiliation(s)
- Wei Fan
- Department of Obstetrics and Gynecology, The West China Second University Hospital, University of Sichuan, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, 20 Renmin Nanlu Road, Chengdu, 610041, People's Republic of China
| | - Zhongying Huang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, University of Sichuan, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, 20 Renmin Nanlu Road, Chengdu, 610041, People's Republic of China
| | - Shangwei Li
- Department of Obstetrics and Gynecology, The West China Second University Hospital, University of Sichuan, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, 20 Renmin Nanlu Road, Chengdu, 610041, People's Republic of China
| | - Zhun Xiao
- Department of Obstetrics and Gynecology, The West China Second University Hospital, University of Sichuan, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, 20 Renmin Nanlu Road, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
17
|
Ahmadi M, Abdolmohammadi-Vahid S, Ghaebi M, Aghebati-Maleki L, Afkham A, Danaii S, Abdollahi-Fard S, Heidari L, Jadidi-Niaragh F, Younesi V, Nouri M, Yousefi M. Effect of Intravenous immunoglobulin on Th1 and Th2 lymphocytes and improvement of pregnancy outcome in recurrent pregnancy loss (RPL). Biomed Pharmacother 2017. [PMID: 28622710 DOI: 10.1016/j.biopha.2017.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Women with elevated natural killer (NK) cell frequency and function during pregnancy, suffer from recurrent pregnancy loss (RPL). In the present study, the possible effect of intravenous immunoglobulin (IVIG) administration on Th1 and Th2 cell frequency, cytokine secretion, and expression of transcription factors is compared between RPL patients and control group. MATERIALS AND METHODS Totally, 44 women with a history of RPL (32 women as treated group and 12 as control group) were enrolled in the study. The frequency of Th1 and Th2 lymphocytes, the expression of transcription factors related to these cells and the serum levels of associated cytokines were assessed by flowcytometry, real-time PCR and ELISA, respectively. All, assessments were performed both before and after treatment with IVIG. RESULTS A significant reduction in Th1 lymphocyte frequency, transcription factor expression and cytokine levels were observed in IVIG-treated group, while all the above parameters indicated a significant increase for Th2 lymphocytes. Th1/Th2 ratio decreased significantly (p value<0.0001) at the end of treatment and 28 out of 32 (87.5%) women in IVIG-treated group had live birth in comparison with 5 out of 12 (41.6%) in untreated group. CONCLUSION IVIG administration proves to be an efficient therapeutic strategy which is able to enhance the success rate of pregnancy through a shift in Th2 responses. Furthermore, IVIG presents efficacy for the treatment of reproduction failures especially in subjects with immune cell abnormalities and increased NK cell level and function.
Collapse
MESH Headings
- Abortion, Habitual/blood
- Abortion, Habitual/drug therapy
- Abortion, Habitual/genetics
- Abortion, Habitual/immunology
- Adult
- Case-Control Studies
- Cells, Cultured
- Cytokines/blood
- Cytokines/immunology
- Cytotoxicity, Immunologic/drug effects
- Female
- Humans
- Immunoglobulins, Intravenous/administration & dosage
- Immunoglobulins, Intravenous/adverse effects
- Immunologic Factors/administration & dosage
- Immunologic Factors/adverse effects
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Live Birth
- Lymphocyte Count
- Pregnancy
- Th1 Cells/drug effects
- Th1 Cells/immunology
- Th1 Cells/metabolism
- Th2 Cells/drug effects
- Th2 Cells/immunology
- Th2 Cells/metabolism
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Treatment Outcome
Collapse
Affiliation(s)
- Majid Ahmadi
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samaneh Abdolmohammadi-Vahid
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Ghaebi
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Aghebati-Maleki
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Afkham
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART Center, Eastern Azerbaijan Branch of ACECR, Tabriz, Iran
| | - Sedigheh Abdollahi-Fard
- Gynecology Department, Eastern Azerbaijan ACECR ART Center, Eastern Azerbaijan Branch of ACECR, Tabriz, Iran
| | - Lida Heidari
- Gynecology Department, Eastern Azerbaijan ACECR ART Center, Eastern Azerbaijan Branch of ACECR, Tabriz, Iran
| | - Farhad Jadidi-Niaragh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Nouri
- Department of Biochemistry and Clinical Laboratories, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
18
|
Hviid MM, Macklon N. Immune modulation treatments—where is the evidence? Fertil Steril 2017; 107:1284-1293. [DOI: 10.1016/j.fertnstert.2017.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
|
19
|
Nakagawa K, Kwak-Kim J, Kuroda K, Sugiyama R, Yamaguchi K. Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures. Am J Reprod Immunol 2017; 78. [PMID: 28466977 DOI: 10.1111/aji.12682] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/05/2017] [Indexed: 01/19/2023] Open
Abstract
PROBLEM We aim to investigate whether the peripheral blood T helper (Th) 1 cell level could predict pregnancy outcome in patients who have experienced repeated implantation failure (RIF, three or more) after ART cycles. METHOD OF STUDY This is a prospective cohort study of total 124 women with RIF who showed elevated Th1/Th2 (CD4+ IFN-γ+ /CD4+ IL-4+ ) cell ratios (≥10.3) and received tacrolimus at Sugiyama Clinic between November 2011 and July 2016. Patients were divided into three groups as per Th1 cell levels: Th1 level of <22.8 as Low; 22.8 to <28.8 as Middle, and 28.8 or greater as High group. The study patients received daily dose of tacrolimus 1-3 mg based on initial Th1/Th2 cell ratio. RESULTS The clinical pregnancy rates of Low, Middle, and High groups were 48.8%, 43.9%, and 33.3%, respectively (P=NS), with tacrolimus treatment. The ongoing pregnancy/delivery rate of Low group (46.3%) was significantly higher than that of High group (21.4%, P<.05). Middle group (34.3%) had higher success rate than High group, albeit without statistical significant. CONCLUSION We confirm our previous report that Th1/Th2 ratio can predict ART outcomes in patients with RIF and immunosuppressant treatment with tacrolimus, and peripheral blood Th1 cell levels were negatively correlated with pregnancy outcome.
Collapse
Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
20
|
Sung N, Han AR, Park CW, Park DW, Park JC, Kim NY, Lim KS, Shin JE, Joo CW, Lee SE, Kim JW, Lee SK. Intravenous immunoglobulin G in women with reproductive failure: The Korean Society for Reproductive Immunology practice guidelines. Clin Exp Reprod Med 2017; 44:1-7. [PMID: 28428937 PMCID: PMC5395546 DOI: 10.5653/cerm.2017.44.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 02/03/2023] Open
Abstract
The task force of the Korean Society for Reproductive Immunology recommends intravenous immunoglobulin G treatment in women with reproductive failure, including recurrent pregnancy loss and/or repeated implantation failure, who show cellular immune factors such as abnormal natural killer cell levels, natural killer cell cytotoxicity, and/or type 1 T helper immunity.
Collapse
Affiliation(s)
- Nayoung Sung
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ae Ra Han
- Department of Obstetrics and Gynecology, Gangseo Mizmedi Hospital, Seoul, Korea
| | - Chan Woo Park
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Dong Wook Park
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Joon Cheol Park
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Na Young Kim
- Department of Obstetrics and Gynecology, Gangnam Mizmedi Hospital, Seoul, Korea
| | | | | | | | - Seung Eun Lee
- Department of Obstetrics and Gynecology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | | | - Sung Ki Lee
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | | |
Collapse
|
21
|
Abdolmohammadi-Vahid S, Danaii S, Hamdi K, Jadidi-Niaragh F, Ahmadi M, Yousefi M. Novel immunotherapeutic approaches for treatment of infertility. Biomed Pharmacother 2016; 84:1449-1459. [DOI: 10.1016/j.biopha.2016.10.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022] Open
|
22
|
Saito S, Shima T, Nakashima A, Inada K, Yoshino O. Role of Paternal Antigen-Specific Treg Cells in Successful Implantation. Am J Reprod Immunol 2015; 75:310-6. [PMID: 26706630 DOI: 10.1111/aji.12469] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/29/2015] [Indexed: 01/21/2023] Open
Abstract
Maternal lymphocytes recognize fetal antigens, so tolerance is necessary to prevent rejection. Seminal plasma is important for induction of paternal antigen-specific Treg cells in the uterine draining lymph nodes and the pregnant uterus. Elimination of Treg cells during implantation or early pregnancy induces implantation failure or fetal resorption in mice. Immunosuppressive therapy with an anti-TNF antibody or the immunosuppressive agent tacrolimus improves the pregnancy rate in women with repeated implantation failure and recurrent pregnancy loss of unknown etiology, suggesting that Treg cells play an essential role in successful implantation and pregnancy in humans.
Collapse
Affiliation(s)
- Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tomoko Shima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Kumiko Inada
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| |
Collapse
|
23
|
Lee SK, Kim JY, Han AR, Hur SE, Kim CJ, Kim TH, Cho BR, Han JW, Han SG, Na BJ, Kwak-Kim J. Intravenous Immunoglobulin G Improves Pregnancy Outcome in Women with Recurrent Pregnancy Losses with Cellular Immune Abnormalities. Am J Reprod Immunol 2015; 75:59-68. [DOI: 10.1111/aji.12442] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Sung Ki Lee
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Jee Yun Kim
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Ae Ra Han
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Sung Eun Hur
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Chul Jung Kim
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Tae Hyun Kim
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Bo Ra Cho
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Jae Won Han
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Sae Geul Han
- Department of Obstetrics and Gynecology; Konyang University Hospital; Daejeon Korea
| | - Baeg Ju Na
- Seoul Metropolitan Seobuk Hosptial; Seoul Korea
| | - Joanne Kwak-Kim
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| |
Collapse
|
24
|
Nardo LG, El-Toukhy T, Stewart J, Balen AH, Potdar N. British Fertility Society Policy and Practice Committee: Adjuvants in IVF: Evidence for good clinical practice. HUM FERTIL 2014; 18:2-15. [DOI: 10.3109/14647273.2015.985454] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
Nakagawa K, Kwak-Kim J, Ota K, Kuroda K, Hisano M, Sugiyama R, Yamaguchi K. Immunosuppression with Tacrolimus Improved Reproductive Outcome of Women with Repeated Implantation Failure and Elevated Peripheral Blood Th1/Th2 Cell Ratios. Am J Reprod Immunol 2014; 73:353-61. [DOI: 10.1111/aji.12338] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
| | - Kuniaki Ota
- Department of Obstetrics and Gynecology; Keio University; Tokyo Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology; Faculty of Medicine; Juntendo University; Tokyo Japan
| | - Michi Hisano
- Department of Maternal-Fetal Biology; National Center for Child Health and Development; Tokyo Japan
| | | | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology; National Center for Child Health and Development; Tokyo Japan
| |
Collapse
|
26
|
Immunomodulatory treatment with intravenous immunoglobulin and prednisone in patients with recurrent miscarriage and implantation failure after in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 2014; 102:1650-5.e1. [PMID: 25256927 DOI: 10.1016/j.fertnstert.2014.08.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess outcome in terms of live-birth rate after fresh or frozen IVF/intracytoplasmic sperm injection assisted reproductive technology (ART) cycles where immunomodulation was given to patients with recurrent pregnancy loss after prior ART treatments. DESIGN Retrospective cohort study. SETTING Tertiary care university hospital. PATIENT(S) Fifty-two patients with a history of at least three consecutive pregnancy losses after ART who underwent at least one further ART cycle with concurrent immunomodulation in 2003-2012. INTERVENTION(S) Immunomodulation with IV immunoglobulin and prednisone starting from before ET and continuing in the first trimester if pregnancy was established. MAIN OUTCOME MEASURE(S) Live-birth rate per ET and cumulative live-birth rate after up to five ETs. RESULT(S) Nineteen patients (36.5%) achieved a live birth after the first ET with immunomodulation, and a total of 32 patients achieved a live birth in the study period, resulting in a cumulative live-birth rate of 61.5%. There was no significant difference in baseline and immunological parameters between the patients achieving a live birth or not. The live-birth rate after the first immunomodulated ART cycle in our patients is higher than that reported in a previous study. CONCLUSION(S) Immunomodulation with a combination of IV immunoglobulin and prednisone is a promising treatment for recurrent pregnancy loss after ART, but randomized placebo-controlled trials are needed.
Collapse
|
27
|
Li J, Chen Y, Liu C, Hu Y, Li L. Intravenous Immunoglobulin Treatment for Repeated IVF/ICSI Failure and Unexplained Infertility: A Systematic Review and a Meta-Analysis. Am J Reprod Immunol 2013; 70:434-47. [PMID: 24238107 DOI: 10.1111/aji.12170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jie Li
- Guangxi Reproductive Medical Research Center; First Affiliated Hospital of Guangxi Medical University; Nanning China
| | - Yang Chen
- Center for Genomic and Personalized Medicine; Guangxi Medical University; Nanning China
- Department of Urology and Nephrology; The First Affiliated Hospital of Guangxi Medical University; Nanning China
| | | | - Yanling Hu
- Center for Genomic and Personalized Medicine; Guangxi Medical University; Nanning China
- Medical Research Center; Guangxi Medical University; Nanning Guangxi China
| | - Liuming Li
- Guangxi Reproductive Medical Research Center; First Affiliated Hospital of Guangxi Medical University; Nanning China
| |
Collapse
|