Other recent studies discuss the effectiveness in RPL treatment of some immunomodulatory agents such as paternal leucocyte immunization (PLI), intravenous immunoglobulin (IVIg), filgrastim and intralipid. 5 Given that, several randomized clinical trials have assessed immune modulators as an approach to address the RPL and/or RIF conditions. The abnormal inflammatory response in RPL and RIF includes increased expression of pro‐inflammatory markers, human leucocyte antigens and circulating natural killer (NK) cells. 3, 4 Studies conducted in recent decade have been suggesting that immunological abnormalities such as self‐recognition of an embryo or foetus could contribute to the implantation failure and thus explain the occurrence of RPL. The implantation rate in women under IVF can vary from 25% to 40% depending on the embryo transfer protocol, and about 10% of patients under IVF are affected with RIF. 3Īlthough the RIF aetiology is not completely established, variables such as maternal age, elevated BMI, immunological factors, sperm quality, uterine alterations and psychological conditions should be considered to direct treatment approaches. Repeated implantation failure (RIF) is a failure to achieve a clinical pregnancy in women under 40 years old after three or more consecutive transfer cycles of at least four good‐quality embryos. Some cases of RPL can benefit from assisted reproduction techniques, among them in vitro fertilization (IVF), an approach where fertilization is performed outside of the body and then the embryo is transferred to the uterus even so, the in vitro transfer can be unsuccessful. More recently, RPL was redefined as two or more spontaneous losses of clinical pregnancies before completing 22 weeks of gestation, affecting around 1%‐2% of women. Recurrent pregnancy loss (RPL) was first defined by the Royal College of Obstetricians and Gynecologists as three or more consecutive miscarriages before the twentieth week of pregnancy, excluding ectopic, molar and biochemical pregnancies. We find that although some authors recommend LET as an effective intervention, more studies are necessary to confirm its effectiveness in restoring NK cell activity to normal levels and to comprehend the underlying mechanisms of the lipids action in ameliorating the maternal environment and improving the pregnancy rate. In this review, we focus on the studies that conducted LET to treat patients with RPL and RIF with abnormal NK cell activity. However, the mechanisms by which the intralipid acts to reduce NK cell activity are still unclear. Currently, lipid emulsion therapy (LET) has emerged as a treatment for RPL and RIF in women with abnormal NK cell activity, by decreasing the exacerbated immune response of the maternal uterus and providing a more receptive environment for the embryo. Immunosuppressors or immunomodulators can help or prevent this condition. Exacerbation of the maternal immune response through increased NK cell activity and inflammatory cytokines can cause embryo rejection leading to abortion or embryo implantation failure. Altered immune and/or inflammatory response plays an important role in cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |