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Causes and risk factors
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Despite advances in understanding of the immunological disruption to pregnancy that can occur in some women, and the availability of treatments that might address some of these conditions, the precise role of the immune system in pregnancy loss remains uncertain. For a pregnancy to be successful, complex adaptations in the immune response need to occur so that the maternal reaction to the embryo, which is essentially 50% foreign tissue, is life-sustaining rather than lethal. Whereas pregnancy was once viewed as a conflict between fetus and maternal immunity, a conceptual reframing has been taking place, and the many cooperative interactions between the two are now emphasised in reproductive immunology.15 When responses go awry, two immunological mechanisms are involved, namely those involving autoimmune factors and alloimmunity.
Immune Testing in Recurrent Pregnancy Loss*
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Jeffrey Braverman, Darren Ritsick, Nadera Mansouri-Attia
As discussed above, SAB testing can be used to detect humoral responses to specific paternal HLA antigens. Reliable assays for the detection of antigen-specific cellular (T cell-mediated) responses have also been developed and have been applied in the setting of transplantation. However, these assays detect allorecognition through direct antigen presentation which is not relevant to pregnancy. Although more technically difficult, similar assays to detect allorecognition through indirect antigen presentation are also being developed. The ability to sensitively and reliably detect both cellular and humoral responses specifically to paternally-derived antigens will significantly advance the field of clinical reproductive immunology.
The Pathophysiology of Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
The male reproductive system apparently possesses simplistic functions so as to produce sperm and testosterone, but the underlying mechanisms are far more complex and yet to be completely revealed. Such elusive mechanisms of male reproductive functions have led to poor understanding of the actual causatives of male infertility in about 50% of the cases [1]. Disruption of male fertility may be reflected by impaired sperm parameters through multivariate factors at different levels [2–4]. Etiologies of male infertility may act at the pretesticular or neuroendocrine regulatory levels. Other factors may directly affect intratesticular sites, thereby afflicting the functions of Sertoli cells, Leydig cells, and germ cells. Disruptions can also occur at the posttesticular strata, impairing sperm maturation and transport. Besides the conventional concept of pathophysiology of male infertility, there is advent in male reproductive immunology as well as reproductive genetics and epigenetics, modulations of which may induce varying forms of impairment to the male fecundity. Proper evaluation of male infertility at different levels is essential for its effective management. Targeted treatment to specific male factor with or without assisted reproductive techniques (ART) may be adopted for management of male infertility [5].
Increased levels of angiotensin II type 1 receptor autoantibodies in female infertility
Published in Systems Biology in Reproductive Medicine, 2021
Fang Liu, Guifang Yang, Ruixia Guo, Li Xue, Lijuan Wang, Jingjing Guo, Xiaoli Yang
Female-related infertility accounts for about 50% of couples’ infertility (Simopoulou et al. 2019), and its pathogenesis is complex, which has not been fully elucidated (Lindsay and Vitrikas 2015). With the development of reproductive immunology, immune factors have been shown to be one of the important causes of infertility (Deroux et al. 2017). Studies have found that reproductive system autoantibodies (including anti-human chorionic gonadotropin, anti-endometrial antibody, anti-ovarian antibody, anti-sperm antibody, etc.) can affect serum estradiol (E2) and progesterone (P) as well as other hormone levels (Yasin et al. 2016), that can also affect other processes like egg discharge, fertilization, embryo implantation. These can cause infertility. However, the known immune antibody screening cannot explain many cases of clinical infertility, so it is urgent to expand the scope of screening.
Healthy immunity: it’s all about immune regulation
Published in International Reviews of Immunology, 2020
The interaction of the mother’s immunity with a genetically distinct (hemiallogenic) developing fetus during gestation period is an excellent example of immune tolerance. The mother’s immunity protects the fetus from infection and support fetal development without developing any immune responses against the fetus. During gestation period, the reorganization of maternal immunity is taking place at the organ, cellular and molecular levels such as restructuring blood vessels in the uterus, development of tolerant innate and adaptive immune cells and production of factors and cytokines from by maternal-fetal origin placenta to develop an immunosuppressive condition. The first review article in this issue by Li et al. discusses the immunology interfaces of a fetus and a mother that result in the immunosuppression on the maternal side, which lead to the full-term development of the fetus.1 This article also provides deep insight of the cellular and molecular basis for immune tolerance that may be helpful in understanding other pathologic aspects of immune suppression induced by developing tumor or cancerous growths in the host. In addition, the article provides potential molecular targets for immune suppression. Overall, this article will be not only be useful to the clinician, particularly gynecologist, but it is also important for researchers working on various interfaces of immunology such as reproductive immunology, tumor-immunology, transplant-immunology, and so on (Figure 1).
Adjuvants in IVF—evidence for what works and what does not work
Published in Upsala Journal of Medical Sciences, 2020
Luciano Nardo, Spyridon Chouliaras
There is no doubt that the immune regulation of the dialogue between the endometrium and the embryo during implantation is fundamental. The so-called immunological paradox of pregnancy though is still not well understood (23). Women desperate to find an explanation for their repeated IVF failures are often worried that their bodies may be rejecting embryos or that the gametes could be incompatible. The anxiety surrounding these theories is only enhanced by unfortunate and sometimes irresponsible media publications and by the specific terminology used in reproductive immunology (e.g., killer, necrosis, etc.). Natural killer (NK) cells, cytokines, tumour necrosis factor-alpha (TNF-α), and the balance between T-helper cells (Th1/Th2) all play a major role in the embryo implantation process.