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

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 th...

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Published inReproduction (Cambridge, England) Vol. 165; no. 2; pp. R39 - R60
Main Authors Genest, Geneviève, Banjar, Shorooq, Almasri, Walaa, Beauchamp, Coralie, Benoit, Joanne, Buckett, William, Dzineku, Frederick, Gold, Phil, Dahan, Michael H, Jamal, Wael, Jacques Kadoch, Isaac, Kadour-Peero, Einav, Lapensée, Louise, Miron, Pierre, Shaulov, Talya, Sylvestre, Camille, Tulandi, Togas, Mazer, Bruce D, Laskin, Carl A, Mahutte, Neal
Format Journal Article
LanguageEnglish
Published England Bioscientifica Ltd 01.02.2023
Subjects
Embryo Implantation
Embryo Transfer
Endometrium - pathology
Female
Humans
Immunity
Immunomodulation
Pregnancy
Review
Treatment Outcome
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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.
AbstractList 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.
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.In briefImmune 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.AbstractRecurrent 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.
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.
Author Jamal, Wael
Benoit, Joanne
Buckett, William
Dahan, Michael H
Tulandi, Togas
Shaulov, Talya
Dzineku, Frederick
Banjar, Shorooq
Kadour-Peero, Einav
Miron, Pierre
Mahutte, Neal
Genest, Geneviève
Beauchamp, Coralie
Gold, Phil
Jacques Kadoch, Isaac
Almasri, Walaa
Lapensée, Louise
Mazer, Bruce D
Laskin, Carl A
Sylvestre, Camille
AuthorAffiliation Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
The Montreal Fertility Centre, Montreal, Quebec, Canada
Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, Toronto, Ontario, Canada
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada
Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
Tripod Medical, Toronto, Ontario
Department of Pediatrics, McGill University, Division of Allergy Immunology and Clinical Dermatology, Montreal Children’s Hospital, McGill University, Montréal, Quebec, Canada
Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Quebec, Canada
McGill University Health Centre Reproductive Centre, Montreal, Quebec, Canada
Fertilys Reproductive Center, Laval, Quebec,
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/36322478$$D View this record in MEDLINE/PubMed
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Snippet In brief Immune dysfunction may contribute to or cause recurrent implantation failure. This article summarizes normal and pathologic immune responses at...
Immune dysfunction may contribute to or cause recurrent implantation failure. This article summarizes normal and pathologic immune responses at implantation...
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SubjectTerms Embryo Implantation
Embryo Transfer
Endometrium - pathology
Female
Humans
Immunity
Immunomodulation
Pregnancy
Review
Treatment Outcome
Title Immunomodulation for unexplained recurrent implantation failure: where are we now?
URI http://dx.doi.org/10.1530/REP-22-0150
https://www.ncbi.nlm.nih.gov/pubmed/36322478
https://www.proquest.com/docview/2731427566
Volume 165
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