In cooperation with

Abstract

Immunologic Disorders in Human Infertility

The process of embryo implantation is of high complexity establishing a dialogue between the (vital) embryo and the immune system of the mother in spe.The maternal immune system does not play a »defensive« role but is used by the embryo (and its specific HLA groups at the implantation front) to support the implantation process and the ensuing pregnancy by accelerating cell division and cell growth (»nurse function«).

For certain types of patient couples (e.g. those with specific receptor defects), the transient absence of an embryo during ART treatments may hinder the implantation process or even render it completely impossible; in general, this applies particularly to cultures with a longer absence of the embryo,e.g. in so called blastocyst cultures.

Our understanding of the pathophysiology of implantation problems is growing and an increasing number of treatment options is emerging, e. g. as part of ART treatments or to lower the risk of a repeated miscarriage in patients with recurrent sponteous abortions (RSA). Given the complexity of the nidation process, and particularly of the embryo-maternal dialogue (i. e. receptor-ligand interactions and cytokine patterns), the primary issue is to aim for as accurate a diagnosis as possible (of the underlying disorder), serving as a basis for the development of specific treatments in patients suffering from nidation problems (repetitive implantation failure = RIF) or RSA.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2010; 6(3):186-204

Keywords
embryo-maternal dialogue, natural killer cells,receptors (KIR-LILR-NKG2), cytokines (G-CSF),autoantibodies, IVIG, RSA, RIF

Wolfgang Würfel
Kinderwunsch Centrum München, München

Würfel W. Immunologische... Gynakol Geburtsmed Gynakol Endokrinol 2010; 6(3): 186-204 publiziert 30.11.10 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2010 ISSN 1614-8533
Reviewer: Ines Doll, Hamburg
und Sylke Reichel-Fentz, Heidelberg