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ART implantation failure and miscarriage in patients with elevated intracellular cytokine ratios: response to immune support therapy.

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journal contribution
posted on 22.11.2019 by Conor Harrity, Lyuda Shkrobot, David Walsh, Kevin Marron

Background: The origins of adverse reproductive outcome can be multifactorial, but the contribution of the maternal immune system is considered debatable. Elevated intracellular cytokine ratios have been proposed, although not universally supported, as a marker for immunological dysfunction in implantation and early pregnancy. Poor patient selection or inadequate treatment or testing may be confounding factors. Specific immunomodulation, in carefully selected sub-populations of ART patients with poor reproductive history, despite transfer of good quality blastocysts, may potentially improve clinical outcomes.

Methods: Intracellular cytokine ratios (CKR) were prospectively assessed in 337 patients presenting with a history of implantation failure and/or pregnancy loss, prior to further treatment, and were found to be elevated in 150 (44.5%). Of this group, 134 agreed to initiate a standardised immunotherapy regime (nutraceuticals, prednisolone & intralipids) to evaluate the efficacy of this proposed therapy. Of the intervention population, a small cohort (

Results: Baseline assessment in the intervention population (

Conclusions: Following immunomodulation, significant improvements in both implantation rate and miscarriage rate were seen in this poor prognosis population. This suggests a possible role for both detailed immuno-evaluation of patients with poor reproductive history with good embryo quality, and application of personalised immunotherapy regimes alongside ART in selected cases. Future randomised controlled trials are needed to definitively evaluate this potentially promising therapeutic approach.

Funding

Sims IVF Clinic.

History

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The original article is available at www.biomedcentral.com

Published Citation

Harrity C, Shkrobot L, Walsh D, Marron K. ART implantation failure and miscarriage in patients with elevated intracellular cytokine ratios: response to immune support therapy. Fertility Research and Practice. 2018;4:7

Publication Date

17/10/2018

Publisher

BioMed Central

PubMed ID

30349731

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