Immunology Of Recurrent Pregnancy Loss And Implantation Failure

Immunology of Recurrent Pregnancy Loss provides doctors and immunologists with the information they need to help couples who experience recurrent pregnancy losses. Sections cover unexplained infertility, repeated in vitro fertilization, embryo transfer failures, history of second or third trimester pregnancy losses of unknown cause, or pregnancy with a history of or active autoimmune and/or alloimmune disease. Reproductive failure (RF), including recurrent pregnancy losses (RPL) and repeated implantation failures (RIF) is rather a syndrome than a disease caused by multiple etiologies, such as anatomical, endocrine, genetic, infectious, immunological, thrombotic and unexplained etiologies, hence this book strives to present the latest information. In 27 chapters, divided in 5 sections, the book introduces the current update of reproductive immunology topics in RF and provides systematic diagnostic guidelines, systemic and immune etiologies and therapeutic approaches. Provides detailed immunological background for understanding the etiology and management of reproduction failure Evaluates various immunological factors involved in the pathogenesis and management of reproduction failure Gives insights into various immunological and therapeutic approaches for reproduction failure

Since a September, 1992, Nature article which read: “Can there be life without LIF?”, researchers now realize that the maternal immune system is both a foe (it can reject the conception) and a friend (immune cells and molecules are also necessary for successful pregnancy). Leukemia Inhibitory Factor (LIF) when absent, prevents embryo implantation in rodents. From fecundation to parturition, immunity acts as a Janus, required but potentially dangerous. However, the complexity and the diversity of immunity in pregnancy deters many from entering the field. This book will try to give a complete overview of immunity from gametes till parturition, in brief, but with complete chapters and subsections, each written by specialists in the field. The importance of the topic relies not only on “the riddle of the fetal allograft”, which is per se fascinating, but on its consequences, linked to the development of IVF and in general, Assisted Reproductive Technologies (ART) / Medicine. Since the discovery that there would not be (mammalian) life without LIF, it has become clear that Immune Molecules, and in general, transient post mating inflammatory reactions are required for successful implantation. Disruptions of this process can lead to implantation failure / sterility. In later stages of pregnancy immunological cells, mostly of the innate immune system, control formation of local spiral arteries. Finally, a state of tolerance establishes itself, whose “break’ leads to immune abortion and the vascular bed is further transformed and enlarged, till delivery, and here again “immunological cytokines” do play a major role and can eventually cause immune mediated abortion. Failure of, not just, the cytokine and cell recognition mediated dialogue, but also the pre and peri-implantation “preparation of the uterus”, as stated, leads to sterility, early pregnancy loss and recurrent abortions. There is also an increasingly stronger argument to implicate immunology in pre-eclampsia. Further still, immunology is also implicated in the control of local infection, mother to child transmission of pathogens (notably, but not limited to, HIV). Finally, pregnancy is the only known physiological phenomenon where the once named “suppressor T cells,” re-emerge as “regulatory T cells”, and play a cardinal role. This E-book provides a complete compendium of gynecological immunology, spanning from fecundation to delivery. Topics also include the role of various cell types (such as T regs ad NK cells) in implantation and uterine changes as well as the genetic regulation of immunological processes. As such it will be of interest not only to fundamental and reproductive immunologists, but more importantly, clinicians in obstetrics and gynecology.

Recurrent pregnancy loss (RPL) is defined as two or more consecutive pregnancy losses before the 20th week of gestation, occuring in 1%–3% of reproductive women. Unexplained RPL (URPL) is a heterogeneous condition affecting approximately 50% of RPL cases, with one contributing factor thought to be a disruption in maternal immune tolerance. Various immune effectors and molecules in the immune-microenvironment establish specific maternal tolerance toward the semi-allogeneic fetus during pregnancy. Immune cells including innate lymphoid cells (ILCs), myeloid cells, T cells and B cells have been found to contribute to maintaining this maternal immunological tolerance during pregnancy. ILCs have been found to be the most abundant immune cells in the pregnant uterus, with many studies focusing on the relationship between RPL and either T cells or natural killer (NK) cells in peripheral blood and the endometrium/decidua. Despite progress in uncovering the roles of NK, and regulatory T cells and cytokines in pregnancy, the immune heterogeneity in patients with URPL remains elusive.

Recurrent Miscarriages (RM) & Implantation Failure (IF) have remained an enigma to clinicians and researchers. Even after ruling out all possible causative factors, 50-60% cases still remain “Unexplained’. A majority of these so called “Unexplained” cases are now found to have immunological basis.This book is going into the Immunological aspects of these clinical dilemmas, demystifying the role of Immunology and Immunotherapy in RM and IF. The authors have been working in the field of Reproductive Immunology and Immunotherapy for the last 25 years and they have come out with this book combining the international studies with their own experience. The purpose of writing this book is to provide a comprehensive treatise about Immunotherapy, so that it can become an acceptable modality of treatment in cases where it is needed and is effective.The book discusses the basics in Reproductive Immunology. The immunological changes occurring during pregnancy, the role of Cell mediated Immunity (T cells), Humoral Immunity including cytokines is explained. The normal immunological mechanisms protecting the embryo are highlighted and how these mechanisms are disturbed leading to RM and IF, is also explained.The first and the most discussed method of Immunotherapy is Lymphocyte Immunization Therapy (LIT). The book has given a complete overview of LIT, describing how it created euphoria when it was first introduced, how it gradually went into disrepute and how it is now making a comeback. As the authors have personal experience of LIT, the book gives a detailed and complete information about this active form of immunotherapy.The book has a special section on case studies where the authors have given some clinical case reports (including some of their own), who were treated for immunological factor in RM/IF and were treated with Immunotherapy. These cases can be a useful guide to the readers.The book will be useful not only for undergraduate and postgraduate students but also for clinicians in their practice and for researchers for review of developments in the field.

This book covers in detail contemporary hypotheses and studies related to the immunology of implantation and provides a practical approach for the application of basic reproductive immunology research to pregnancy complications such as preeclampsia, pre-term labor and IUGR. Provides complete and up to date review of current knowledge of the role of the immune system during pregnancy and the interactions between the placenta and the maternal immune system.

This book presents the discipline of immunology which studies a unique physiological phenomenon contradicting many of the generally established rules in the field: immunology of pregnancy. It provides a wide overview of the current research of this topic. Prominent and leading international groups contributed by reviewing the most significant findings in the field.

This book offers a highly informative guide to treating unexplained infertility and recurrent miscarriage (RM). In particular, it provides detailed treatment strategies for infertility or RM derived from uterine circumstance such as chronic endometritis and perturbation of endometrial decidualization, as well as maternal immunological rejection of an embryo as semi-allograft. Unexplained infertility refers to those types that cannot be detected by the general screening test. The causes are sometimes detected in the course of treatment with assisted reproductive technology including IVF. However, some unexplained infertility is intractable even after intracytoplasmic sperm injection or repeated implantation of morphologically suitable embryos. Patients with unexplained RM also have a high likelihood of undetectable risk factors of miscarriage. As a result, gynecologists often repeatedly provide these couples with general treatments for infertility and miscarriage or even discontinue treatment because they cannot detect the reason, which places serious financial, physical and mental burdens on the couples affected. This book offers gynecologists essential insights into the pathological condition of unexplained infertility and RM, equipping them to identify it, explain it to patients, and consider further examinations and more aggressive fertility treatments.

The author explores similarities in two complications that occur at different points in pregnancies - miscarriage, being a first trimester condition, and pre-eclampsia, being a third trimester condition - and the roles of antioxidants and the immune system in both conditions.