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Khairy M, Harb H, Eapen A, Melo P, Kazem R, Rajkhowa M, Ndukuwe G, Coomarasamy A. The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study. Am J Reprod Immunol 2024; 91:e13819. [PMID: 38348954 DOI: 10.1111/aji.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
PROBLEM Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S) This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.
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Affiliation(s)
| | - Hoda Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Abey Eapen
- Department of Obstetrics and Gynaecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pedro Melo
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | | | | | | | - Arri Coomarasamy
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
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Cimadomo D, de los Santos MJ, Griesinger G, Lainas G, Le Clef N, McLernon DJ, Montjean D, Toth B, Vermeulen N, Macklon N. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023; 2023:hoad023. [PMID: 37332387 PMCID: PMC10270320 DOI: 10.1093/hropen/hoad023] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
STUDY QUESTION How should recurrent implantation failure (RIF) in patients undergoing ART be defined and managed? SUMMARY ANSWER This is the first ESHRE good practice recommendations paper providing a definition for RIF together with recommendations on how to investigate causes and contributing factors, and how to improve the chances of a pregnancy. WHAT IS KNOWN ALREADY RIF is a challenge in the ART clinic, with a multitude of investigations and interventions offered and applied in clinical practice, often without biological rationale or with unequivocal evidence of benefit. STUDY DESIGN SIZE DURATION This document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available, and the results of a previously published survey on clinical practice in RIF and the expertise of the working group. A literature search was performed in PubMed and Cochrane focussing on 'recurrent reproductive failure', 'recurrent implantation failure', and 'repeated implantation failure'. PARTICIPANTS/MATERIALS SETTING METHODS The ESHRE Working Group on Recurrent Implantation Failure included eight members representing the ESHRE Special Interest Groups for Implantation and Early Pregnancy, Reproductive Endocrinology, and Embryology, with an independent chair and an expert in statistics. The recommendations for clinical practice were formulated based on the expert opinion of the working group, while taking into consideration the published data and results of the survey on uptake in clinical practice. The draft document was then open to ESHRE members for online peer review and was revised in light of the comments received. MAIN RESULTS AND THE ROLE OF CHANCE The working group recommends considering RIF as a secondary phenomenon of ART, as it can only be observed in patients undergoing IVF, and that the following description of RIF be adopted: 'RIF describes the scenario in which the transfer of embryos considered to be viable has failed to result in a positive pregnancy test sufficiently often in a specific patient to warrant consideration of further investigations and/or interventions'. It was agreed that the recommended threshold for the cumulative predicted chance of implantation to identify RIF for the purposes of initiating further investigation is 60%. When a couple have not had a successful implantation by a certain number of embryo transfers and the cumulative predicted chance of implantation associated with that number is greater than 60%, then they should be counselled on further investigation and/or treatment options. This term defines clinical RIF for which further actions should be considered. Nineteen recommendations were formulated on investigations when RIF is suspected, and 13 on interventions. Recommendations were colour-coded based on whether the investigations/interventions were recommended (green), to be considered (orange), or not recommended, i.e. not to be offered routinely (red). LIMITATIONS REASONS FOR CAUTION While awaiting the results of further studies and trials, the ESHRE Working Group on Recurrent Implantation Failure recommends identifying RIF based on the chance of successful implantation for the individual patient or couple and to restrict investigations and treatments to those supported by a clear rationale and data indicating their likely benefit. WIDER IMPLICATIONS OF THE FINDINGS This article provides not only good practice advice but also highlights the investigations and interventions that need further research. This research, when well-conducted, will be key to making progress in the clinical management of RIF. STUDY FUNDING/COMPETING INTERESTS The meetings and technical support for this project were funded by ESHRE. N.M. declared consulting fees from ArtPRED (The Netherlands) and Freya Biosciences (Denmark); Honoraria for lectures from Gedeon Richter, Merck, Abbott, and IBSA; being co-founder of Verso Biosense. He is Co-Chief Editor of Reproductive Biomedicine Online (RBMO). D.C. declared being an Associate Editor of Human Reproduction Update, and declared honoraria for lectures from Merck, Organon, IBSA, and Fairtility; support for attending meetings from Cooper Surgical, Fujifilm Irvine Scientific. G.G. declared that he or his institution received financial or non-financial support for research, lectures, workshops, advisory roles, or travelling from Ferring, Merck, Gedeon-Richter, PregLem, Abbott, Vifor, Organon, MSD, Coopersurgical, ObsEVA, and ReprodWissen. He is an Editor of the journals Archives of Obstetrics and Gynecology and Reproductive Biomedicine Online, and Editor in Chief of Journal Gynäkologische Endokrinologie. He is involved in guideline developments and quality control on national and international level. G.L. declared he or his institution received honoraria for lectures from Merck, Ferring, Vianex/Organon, and MSD. He is an Associate Editor of Human Reproduction Update, immediate past Coordinator of Special Interest Group for Reproductive Endocrinology of ESHRE and has been involved in Guideline Development Groups of ESHRE and national fertility authorities. D.J.M. declared being an Associate Editor for Human Reproduction Open and statistical Advisor for Reproductive Biomedicine Online. B.T. declared being shareholder of Reprognostics and she or her institution received financial or non-financial support for research, clinical trials, lectures, workshops, advisory roles or travelling from support for attending meetings from Ferring, MSD, Exeltis, Merck Serono, Bayer, Teva, Theramex and Novartis, Astropharm, Ferring. The other authors had nothing to disclose. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.
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Affiliation(s)
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - G Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- University of Luebeck, Luebeck, Germany
| | - G Lainas
- Eugonia IVF, Unit of Human Reproduction, Athens, Greece
| | - N Le Clef
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - D J McLernon
- School of Medicine Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - D Montjean
- Fertilys Fertility Centers, Laval & Brossard, Canada
| | - B Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - N Vermeulen
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - N Macklon
- Correspondence address. ESHRE Central Office, BXL7—Building 1, Nijverheidslaan 3, B-1853 Strombeek-Bever, Belgium. E-mail:
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Xia Q, Wang W, Liu Z, Xiao J, Qiao C, Zhao Y, Li B, Liu Y, Peng Y, Yang X, Shi J, Gao X, Wang D. New insights into mechanisms of berberine in alleviating reproductive disorders of polycystic ovary syndrome: Anti-inflammatory properties. Eur J Pharmacol 2023; 939:175433. [PMID: 36535493 DOI: 10.1016/j.ejphar.2022.175433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex reproductive disorder that seriously harms female reproductive health and decreases quality of life. Although spontaneous or assisted ovulation occurs, women with PCOS suffer from poor-quality oocytes and embryos and lower fertilization and final pregnancy rates. Therefore, it is urgent to identify new pathological mechanisms and discover the underlying therapeutic targets for reproductive disorders associated with PCOS. Berberine, one of the famous traditional Chinese medicines, has been shown to improve ovulation and live birth rates in women with PCOS. The effects of berberine on insulin resistance and abnormal glucose and lipid metabolism for restoring the reproductive health of women with PCOS are well recognized and have been widely studied, but much less attention has been given to its anti-inflammatory properties. Chronic low-grade inflammation is the unifying feature of PCOS and may contribute to reproductive disorders in PCOS. Berberine can modulate the inflammatory state of the ovaries and uterus in PCOS. The anti-inflammatory properties of berberine may provide new insight into the mechanisms by which berberine alleviates reproductive disorders associated with PCOS. Here, we summarized the most recent insights into the anti-inflammatory properties of berberine in PCOS reproductive disorders to inspire researchers to pursue new study directions involving berberine.
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Affiliation(s)
- Qing Xia
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Wenjing Wang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Zijie Liu
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Jiaying Xiao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Cong Qiao
- Department of Pathology, Harbin Medical University, Harbin, China
| | - Yu Zhao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Bowen Li
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Yuanli Liu
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China
| | - Yahui Peng
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China
| | - Xinyu Yang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Jiabin Shi
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Xu Gao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China.
| | - Dayong Wang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China.
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Zhu Y, Zhao Q, Huang Q, Li Y, Yu J, Zhang R, Liu J, Yan P, Xia J, Guo L, Liu G, Yang X, Zeng J. Nuciferine Regulates Immune Function and Gut Microbiota in DSS-Induced Ulcerative Colitis. Front Vet Sci 2022; 9:939377. [PMID: 35909691 PMCID: PMC9328756 DOI: 10.3389/fvets.2022.939377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Nuciferine, a major aporphine alkaloid obtained from the leaves of Nelumbo nucifera, exhibits anti-cancer and anti-inflammatory properties; however, its protective effects against inflammatory bowel diseases (IBD) has never been explored. In this study, an ulcerative colitis (UC) model was established in BALb/c mice by the continuous administration of 5% dextran sulfate sodium (DSS) in drinking water for 1 week. From day 8 to day 14, the DSS-treated mice were divided into a high-dose and a low-dose nuciferine treatment group and were intraperitoneally injected with the corresponding dose of the drug. Body weight loss, disease activity index (DAI), and colon length were measured. Histological changes were observed using hematoxylin and eosin staining. T lymphocyte proliferation was assessed by MTT assay. The ratio of CD3+, CD4+, CD8+, Th1, Th2, Th17, and Treg cells were estimated by flow cytometry. Finally, 16S rRNA sequencing was performed to compare the composition and relative abundance of the gut microbiota among the different treatment groups. The results showed that nuciferine treatment led to a significant improvement in symptoms, such as histological injury and colon shortening in mice with DSS-induced UC. Nuciferine treatment improved the Th1/Th2 and Treg/Th17 balance in the DSS-induced IBD model, as well as the composition of the intestinal microflora. At the phylum level, compared with the control group, the abundance of Firmicutes and Actinobacteriota was decreased in the model group, whereas that of Bacteroidetes increased. Meanwhile, at the genus level, compared with the control group, the numbers of the genera Lachnospiraceae_Clostridium, Bilophila and Halomonas reduced in the model group, while those of Bacteroides, Parabacteroides, and Paraprevotella increased. Notably, nuciferine administration reversed this DSS-induced gut dysbiosis. These results indicated that nuciferine modulates gut microbiota homeostasis and immune function in mice with DSS-induced UC.
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Affiliation(s)
- Yiling Zhu
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Qing Zhao
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Qi Huang
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Yana Li
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Jie Yu
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Rui Zhang
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Jiali Liu
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Pupu Yan
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Jinjin Xia
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Liwei Guo
- College of Animal Science, Yangtze University, Jingzhou, China
- *Correspondence: Liwei Guo
| | - Guoping Liu
- College of Animal Science, Yangtze University, Jingzhou, China
- Guoping Liu
| | - Xiaolin Yang
- College of Animal Science, Yangtze University, Jingzhou, China
| | - Jianguo Zeng
- College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
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Eidizadeh A, Papert S, Valk J, Pollok-Kopp B, Goldmann M, Riggert J, Moltrecht R, Legler TJ. Adverse drug reactions following lymphocyte immunotherapy for the treatment of infertility: A retrospective study. J Obstet Gynaecol Res 2022; 48:2571-2582. [PMID: 35775609 DOI: 10.1111/jog.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
AIM Unexplained infertility is a major burden for couples who want to have children. Lymphocyte immunotherapy (LIT) could be a therapeutic help for these couples. Although LIT has been carried out for decades, the data on the success of therapy are still controversial and there is hardly information on possible adverse drug reactions. METHODS In this study, we used a questionnaire to determine the frequency of local and systemic adverse drug reactions in our patients who were treated with LIT between 2017 and 2020 (n = 302). In addition, we asked about pregnancies and/or live births after LIT in a 2-year follow-up (n = 140). RESULTS Most of the patients reported the occurrence of mild local adverse drug reactions in a period of less than 4 weeks: Over 75% reported moderate erythema, itching or swelling, over 10% erythema, itching or swelling as more pronounced adverse drug reaction. Blistering was specified in 10% of the cases. Serious adverse drug reactions or adverse events were not described. In the follow-up, 69% of our patients stated a pregnancy after LIT, and 50% a life birth. CONCLUSIONS Overall, LIT represents a well-tolerated therapy for couples with unexplained infertility, however, more evidence is needed on the benefits.
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Affiliation(s)
- Abass Eidizadeh
- Institute for Clinical Chemistry/Interdisciplinary UMG Laboratory, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Papert
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jakob Valk
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Beatrix Pollok-Kopp
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Monika Goldmann
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | | | - Tobias J Legler
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
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Ying Q, Pei Y, Jiang W, Zheng C. Astilbin Improves Pregnancy Outcome in Rats with Recurrent Spontaneous Abortion by Regulating Th1/Th2 balance. Immunopharmacol Immunotoxicol 2022; 44:663-670. [PMID: 35536035 DOI: 10.1080/08923973.2022.2075753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of astilbin on pregnancy outcome in rats with recurrent spontaneous abortion (RSA). METHODS A total of 40 pregnant female Sprague Dawley rats were randomly divided into four groups: the control, model, astilbin, and prednisone groups. An RSA rat model was established by gavage with hydroxyurea and mifepristone. The number of surviving and reabsorbed embryos were counted on day 9 of gestation in each group. The rat serum was collected to detect the levels of IFN-γ, IL-2, IL-4, and IL-10 by enzyme-linked immunosorbent assay. The expressions of T-bet and GATA-3 in the decidual and placental tissues of the rats were determined by immunohistochemistry. RESULTS The absorptivity of embryos was significantly higher in the model group than in the control group. The levels of serum IFN-γ and IL-2 were significantly lower in the astilbin group than in the model group, while the levels of serum IL-4 and IL-10 were significantly higher. Astilbin treatment significantly increased GATA-3 expression, while it significantly reduced T-bet expression and the T-bet/GATA-3 ratio. CONCLUSIONS Astilbin has a therapeutic effect on RSA in rats by regulating the balance of Th1/Th2 in maternal circulation and likely in decidual tissue.
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Affiliation(s)
- Qian Ying
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yue Pei
- Department of Laboratory Medicine, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Wei Jiang
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Caihong Zheng
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
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Lan Y, Li Y, Yang X, Lei L, Liang Y, Wang S. Progesterone-induced blocking factor-mediated Th1/Th2 balance correlates with fetal arrest in women who underwent in vitro fertilization and embryo transfer. Clin Immunol 2021; 232:108858. [PMID: 34560282 DOI: 10.1016/j.clim.2021.108858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/22/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
The role of progesterone-induced blocking factor (PIBF)-mediated Th1/Th2 balance in delivery outcomes of in vitro fertilization and embryo transfer (IVF-ET) has not been fully elucidated. In this study, 73 infertile women with successful IVF-ET were enrolled (16 fetal arrests and 57 live births). PIBF and IL-4 levels were significantly lower in the fetal arrest group than in the live birth group (p < 0.05). TNF-α level and Th1/Th2 ratios were significantly higher in the fetal arrest group than in the live birth group (p < 0.05). High TNF-α level and Th1/Th2 ratios were risk factors for fetal arrest, whereas increased PIBF and IL-4 levels were protective factors (P < 0.05). Increased TNF-α/IL-4 exhibited relatively strong predictive value for fetal arrest (AUC, 0.855; sensitivity, 93.8%; specificity, 71.9%). In summary, the PIBF-mediated Th1/Th2 balance is closely correlated with delivery outcomes of IVF-ET. TNF-α/IL-4 may be a predictive marker of fetal arrest.
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Affiliation(s)
- Yonglian Lan
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China
| | - Ying Li
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China
| | - Xiaokui Yang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China
| | - Lingling Lei
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China
| | - Yu Liang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China.
| | - Shuyu Wang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China.
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Makrigiannakis A, Makrygiannakis F, Vrekoussis T. Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures. Front Cell Dev Biol 2021; 9:613277. [PMID: 33796523 PMCID: PMC8007915 DOI: 10.3389/fcell.2021.613277] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
Repeated implantation failures are a constant challenge in reproductive medicine with a significant impact both on health providers and on infertile couples. Several approaches have been proposed so far as effective; however, accumulative data have clarified that most of the treatment options do not have the evidence base for a generalized application to be suggested by the relevant societies. Implantation failures are attributed to either poor quality embryos or to defected endometrial receptivity. The current review aims to summarize in a systematic way all the new trends in managing RIF via interference with endometrial receptivity. The authors focus mainly, but not exclusively, on endometrial injury prior to embryo transfer and endometrial priming with autologous cells or biological agents. To this direction, a systematic search of the Pubmed database has been conducted taking into account the emerged evidence of the last two decades. All the suggested interventions are herein presented and analyzed in terms of reproductive outcomes. It is evident that properly powered and designed randomized trials are needed to support a new standard approach in RIF treatment that will safely be incorporated in national and international guidelines.
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Affiliation(s)
- Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | | | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
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9
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Santiago KY, Porchia LM, López-Bayghen E. Endometrial preparation with etanercept increased embryo implantation and live birth rates in women suffering from recurrent implantation failure during IVF. Reprod Biol 2021; 21:100480. [PMID: 33476990 DOI: 10.1016/j.repbio.2021.100480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/03/2020] [Accepted: 01/02/2021] [Indexed: 12/16/2022]
Abstract
Recurrent implantation failure (RIF), defined as ≥3 failed in vitro fertilization (IVF) cycles with the accumulated transfer of at least five embryos, plague many infertile women. The exact cause is unknown; however, evidence supports the immune system, specifically the Tumor Necrosis Factor (TNF) pathway. Etanercept (a TNFα antagonist) has been shown to improve pregnancy rates in women with rheumatoid arthritis or endometriomas; therefore, this study aimed to determine the effectiveness of etanercept for IVF in RIF women. Eighty-three RIF women were recruited from the Ingenes Institute in Mexico City for this single-arm, prospective study. All patients underwent a similar IVF protocol and received etanercept (4 × 25 mg every 72 h) after endometrial preparation, if applicable, and at embryo transfer. IVF endpoints assessed were embryo implantation (h-βCG >10 mg/dL at Day 14), the presence of a gestational sac, live birth, and birth weight. All women reported no side-effects associated with the etanercept treatment. 75.9 % of the cohort achieved embryo implantation, 74.7 % developed gestational sacs, and the ongoing pregnancy/live birth rate was at 62.7 %. However, 56.7 % of the live births were preterm (<37 weeks) and 60.5 % of the births were underweight (<2500 g). When stratified by fresh or frozen cycles or by the ova source (patient versus donor), the results were not significantly different with respect to the implantation rate, formation of gestational sacs, and the live birth rate. Here, we showed that using etanercept during endometrial preparation improves IVF outcomes in RIF women.
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Affiliation(s)
- Karla Y Santiago
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, México
| | - Leonardo M Porchia
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, México
| | - Esther López-Bayghen
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), México City, México.
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Luo J, Wang Y, Qi Q, Cheng Y, Xu W, Yang J. Sinomenine Improves Embryo Survival by Regulating Th1/Th2 Balance in a Mouse Model of Recurrent Spontaneous Abortion. Med Sci Monit 2021; 27:e927709. [PMID: 33390585 PMCID: PMC7791895 DOI: 10.12659/msm.927709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background This study aims to explore the effect of Sinomenine (SIN) on pregnancy outcomes of recurrent spontaneous abortion (RSA) in a mouse model. Material/Methods Thirty female CBA/J mice were allocated into 3 groups randomly, then mated with BALB/c mice (CBA/J×BALB/c) as normal-pregnancy group (n=10), or mated with DBA/2 mice (CBA/J×DBA/2) as RSA model (n=10), or CBA/J×DBA/2 mice treated with SIN as RSA+SIN group (n=10). The number of surviving and reabsorbed embryos in each group were counted on day 13.5 of gestation. The mouse serum was collected to determine the levels of interferon-γ (IFN)-γ and IL-4 by ELISA. Immunohistochemistry, qRT-PCR and immunoblotting were used to determine the location, mRNA and protein expressions of IFN-γ, IL-4, T-bet and GATA3 in the decidual and placental tissue. Results In the RSA group, the amount of reabsorbed embryo was significantly higher than that in the normal-pregnancy group. However, SIN treatment showed a rescue effect on spontaneous abortion in RSA mice. IFN-γ, IL-4, T-bet, and GATA3 were all expressed in placental tissues and mainly located in the cytoplasm. The RSA group demonstrated higher expression levels of IFN-γ and T-bet than in the RSA+SIN and normal-pregnancy groups. Although RSA and RSA+SIN groups showed lower expression levels of IL-4 and GATA3 than in the normal-pregnancy group, there was no significant difference between RSA and RSA+SIN groups regarding IL-4 and GATA expression levels. Conclusions SIN treatment demonstrates a therapeutic effect on spontaneous abortion in RSA mice, possibly through regulating the balance of Th1/Th2 in maternal circulation and decidual tissues.
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Affiliation(s)
- Jin Luo
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
| | - Yaqin Wang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
| | - Qianrong Qi
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
| | - Yan Cheng
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
| | - Wangming Xu
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
| | - Jing Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei, China (mainland)
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Pirtea P, De Ziegler D, Tao X, Sun L, Zhan Y, Ayoubi JM, Seli E, Franasiak JM, Scott RT. Rate of true recurrent implantation failure is low: results of three successive frozen euploid single embryo transfers. Fertil Steril 2021; 115:45-53. [DOI: 10.1016/j.fertnstert.2020.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/13/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022]
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12
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Guo Z, Xu Y, Zheng Q, Liu Y, Liu X. Analysis of chromosomes and the T helper 17 and regulatory T cell balance in patients with recurrent spontaneous abortion. Exp Ther Med 2020; 19:3159-3166. [PMID: 32256804 PMCID: PMC7086275 DOI: 10.3892/etm.2020.8537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
The present study investigated the genetic etiology and possible immunological pathogenesis of recurrent spontaneous abortion by analyzing chromosome abnormalities, and the balance between T helper 17 (Th17) and regulatory T (Treg) cells. A total of 54 patients with recurrent spontaneous abortion were selected. The villus and decidual tissues, and peripheral venous blood were collected from each patient. Villus chromosome analysis was performed by high-throughput gene sequencing. Flow cytometry was used to detect Th17 and Treg cells in patients without chromosome abnormalities (n=30) and the control group (normal pregnancy; n=32). Immunoglobulin (IG) combined with human chorionic gonadotropin hormone (HCG) treatment was given to patients without chromosome abnormalities (n=30). Changes in the expression levels of Th17 and Treg cells before and after treatment were compared with patients with successful pregnancy (n=18). Before treatment, compared with the control group, the proportion of Th17 cells in peripheral blood and decidual tissue was increased and the proportion of Treg cells decreased. After treatment, compared with patients before treatment, the proportion of Th17 cells decreased and Treg cells increased, and the Th17 and Treg cells balance was reversed with a biased towards Treg cells. The present results suggested that the Th17 and Treg cell immune imbalance may be an important immune factor in recurrent spontaneous abortion. IG combined with HCG therapy may improve pregnancy outcomes by reversing the imbalance between Th17 and Treg cells.
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Affiliation(s)
- Zhaorong Guo
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong 264400, P.R. China
| | - Yanting Xu
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong 264400, P.R. China
| | - Qiaoling Zheng
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong 264400, P.R. China
| | - Yunyun Liu
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong 264400, P.R. China
| | - Xiaoyan Liu
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong 264400, P.R. China
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Effect of GnRHa on Th17/Treg cells in peripheral blood of patients with unexplained repeated implantation failure. Arch Gynecol Obstet 2018; 298:1211-1218. [PMID: 30251156 DOI: 10.1007/s00404-018-4874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the effect and possible mechanism of downregulation of gonadotropin-releasing hormone agonist (GnRHa) on Th17/Treg (regulatory T cell) cells in peripheral blood of patients with unexplained repeated implantation failure (RIF). METHODS Fifty-two patients who had RIF (≥ 3 consecutive transfers of ≥ 4 high-grade embryos in women under the age of 40 (excluding 40)) of frozen-thawed embryos were studied. Twenty-nine cases receiving simple hormone replacement therapy (HRT) were defined as transfer group, and the remaining 23 cases with HRT combined with GnRHa downregulation were defined as GnRHa downregulation group. In addition, 30 cases of the normal early pregnancy group were selected as control group. RESULTS Before HRT, the number of Th17 and Treg cells in CD4+ lymphocytes was increased and decreased, respectively, with the ratio of Th17/Treg cells increased in HRT group compared with the control group (p < 0.05). On the day of progesterone conversion, compared with the HRT group, the percentage of Th17 and Treg cells was decreased and increased, respectively, with the ratio of Th17/Treg cells decreased significantly in GnRHa downregulation group (p < 0.05). The estrogen E2 levels of the GnRHa downregulation group were slightly higher than those of the HRT group, with no significant difference between the two groups (p > 0.05). Further, there was no significant difference in the levels of chorionic gonadotropin at the 14th day and the 21st day after transplantation between HRT group and GnRHa downregulation group (p > 0.05). CONCLUSION There were an increase and a decrease in the number of Th17 and Treg cells, respectively, with Th17/Treg cells imbalanced in unexplained RIF. GnRHa downregulation may play a direct immunomodulatory role in disrupting the imbalance and then improve the endometrial receptivity. These effects did not depend on the E2 levels in peripheral blood, nor affect early embryonic development.
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Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure. Biomed Pharmacother 2018; 107:1277-1285. [PMID: 30257342 DOI: 10.1016/j.biopha.2018.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cellular immune abnormalities such as the imbalance between T-helper (Th) 1 and Th2 cytokines have been implicated as potentially modifiable causes of idiopathic repeated implantation failures (RIF). The purpose of this study was to investigate the effects of hydroxychloroquine on IL-10 and TNF-α secretion, expression of T-bet and GATA-3 transcription factors and cellular localization of TNF-α, IFN-γ, IL-10 and IL-4 in endometrial cells in women with RIF. MATERIALS AND METHODS A total of 17 women with a history of RIF and elevated TNFα/IL-10 ratio (TNFα/IL-10> = 30.6) were included in the study. The serum levels of TNFα and IL-10, the expression of transcription factors related to Th1 and Th2 cells and the immune-reactivity of TNFα, IFN-γ as Th1 related cytokines and IL-10, IL-4 as Th2 related cytokines in endometrial tissues were evaluated by ELISA, real-time PCR, and fluorescent immunohistochemistry respectively. All, evaluations were done both before and after treatment with hydroxychloroquine (400 mg/orally per day). RESULTS Hydroxychloroquine treatment significantly decreased (p < 0.0001) serum level of TNF-α and significantly increased serum level of IL-10 (p < 0.0001). T-bet, the Th1 transcription factor, expression was down-regulated and GATA-3, the Th2 transcription factor, expression was up-regulated. IL-10 and IL-4 fluorescent immunoreactivities significantly increased (p < 0.05 and p < 0.001 respectively) and TNFα and IFN-γ fluorescent immunoreactivities significantly decreased (p < 0.05) in endometrial tissue in women with RIF after treatment in comparison with before treatment. CONCLUSION Hydroxychloroquine administration in women with RIF With a high TNF-α/IL-10 ratio during the implantation window can decrease this ratio and seems to be an effective therapeutic strategy in RIF caused by cellular immune abnormalities through a shift in Th2 responses.
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Xu B, Zhou M, Wang J, Zhang D, Guo F, Si C, Leung PCK, Zhang A. Increased AIF-1-mediated TNF-α expression during implantation phase in IVF cycles with GnRH antagonist protocol. Hum Reprod 2018; 33:1270-1280. [PMID: 29897458 PMCID: PMC6012176 DOI: 10.1093/humrep/dey119] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is allograft inflammatory factor-1 (AIF-1), a cytokine associated with inflammation and allograft rejection, aberrantly elevated in in vitro fertilization (IVF) cycles with gonadotropin-releasing hormone (GnRH) antagonist protocol with potential effects on endometrial receptivity? SUMMARY ANSWER Our findings indicated AIF-1 is increased in IVF cycles with GnRH antagonist protocol and mediates greater TNF-α expression during implantation phase, which may be unfavorable for embryo implantation. WHAT IS KNOWN ALREADY Studies have shown that GnRH antagonist protocol cycles have lower implantation and clinical pregnancy rates than GnRH agonist long protocol cycles. Endometrial receptivity but not embryo quality is a key factor contributing to this phenomenon; however, the mechanism is still unknown. STUDY DESIGN, SIZE, DURATION Implantation and pregnancy rates were studied in 238 patients undergoing their first cycle of IVF/ICSI between 2012 and 2014. Forty of these patients opted to have no fresh embryo replacement and were divided into two equal groups: (i) GnRH antagonist protocol and (ii) GnRH agonist long protocol, group 3 included 20 infertile women with a tubal factor in untreated cycles. During the same interval, endometrial tissues were taken from 18 infertile women with a tubal factor in the early proliferative phase, late proliferative phase, and mid-secretory phase of the menstrual cycle (n = 6/group). PARTICIPANTS/MATERIALS, SETTING, METHODS Microarray analysis, RT-qPCR, Western blot analysis, immunohistochemistry were used to investigate the expression levels of AIF-1 and the related cytokines (TNF-α, IL1β, IL1RA, IL6, IL12, IL15 and IL18). The effect of AIF-1 on uterine receptivity was modeled using in vitro adhesion experiments (coculture of JAR cells and Ishikawa cells). MAIN RESULTS AND THE ROLE OF CHANCE The expression of AIF-1 was the highest in early proliferative phase, decreasing thereafter in the late proliferative phase, and almost disappearing in the mid-secretory phase, indicating that low AIF-1 expression might be important for embryo implantation during implantation phase. Microarray results revealed that AIF-1 was upregulated in the antagonist group compared with the control group (fold change [FC] = 3.75) and the agonist (FC = 2.20) group. The raw microarray data and complete gene expression table were uploaded to GEO under the accession number of GSE107914. Both the mRNA and protein expression levels of AIF-1 and TNF-α were the higher in the antagonist group than in the other two groups (P < 0.05) which did not differ significantly (P > 0.05). The protein levels of TNF-α in both Ishikawa cells and primary endometrial cells were significantly increased (P < 0.05) at 96 h after transfection with the AIF-1 expression vector, indicating that TNF-α was mediated by AIF-1 in endometrial cells. Overexpression of AIF-1 in Ishikawa cells inhibited adhesion of JAR cells to them. Thus, increased AIF-1 might inhibit adhesion during implantation via raised TNF-α. LIMITATIONS REASONS FOR CAUTION The sample size of the microarray was small, which might weaken the accuracy of our results; however, the sample size of RT-qPCR and the Western blotting assays were sufficient to compensate for this deficiency in our study. In addition, the aberrant AIF-1 and thus TNF-α expression is one of many factors that may contribute to limiting implantation success. Therefore, further extensive in vitro mechanistic and in vivo animal studies are needed to assess the actual functional impact of this pathway. WIDER IMPLICATIONS OF THE FINDINGS Anti-TNF-α therapy might mitigate the adverse effects of GnRH antagonist on endometrial receptivity and improve the implantation rate in GnRH antagonist protocols in IVF. STUDY FUNDING/COMPETING INTERESTS This work was supported by grants from the National Natural Science Foundation of China, Grant numbers 81771656 and 81370763; Clinical research special fund of Chinese Medical Association, Grant number 16020480664; Shanghai Jiao Tong University Medicine-Engineering Fund, Grant number YG2017ZD11 and YG2017MS57; and the Merck-Serono China Research Fund for Fertility Agreement. P.C.K.L. is supported by a Canadian Institutes of Health Research Foundation Scheme Grant 143317. None of the authors has any competing interests.
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Affiliation(s)
- Bufang Xu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Mingjuan Zhou
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Jingwen Wang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Dan Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Feng Guo
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Chenchen Si
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
| | - Peter C K Leung
- Department of Obstetrics and Gynaecology, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aijun Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, China
- Shanghai Key Laboratory of Reproductive Medicine, 280 South Chongqing Road, Shanghai, China
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Sung N, Salazar García MD, Dambaeva S, Beaman KD, Gilman-Sachs A, Kwak-Kim J. Gonadotropin-releasing hormone analogues lead to pro-inflammatory changes in T lymphocytes. Am J Reprod Immunol 2016; 76:50-8. [DOI: 10.1111/aji.12522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Nayoung Sung
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
| | - María D. Salazar García
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
| | - Svetlana Dambaeva
- Department of Microbiology and Immunology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Kenneth D. Beaman
- Department of Microbiology and Immunology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Alice Gilman-Sachs
- Department of Microbiology and Immunology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Joanne Kwak-Kim
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
- Department of Microbiology and Immunology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
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Liang PY, Diao LH, Huang CY, Lian RC, Chen X, Li GG, Zhao J, Li YY, He XB, Zeng Y. The pro-inflammatory and anti-inflammatory cytokine profile in peripheral blood of women with recurrent implantation failure. Reprod Biomed Online 2015; 31:823-6. [DOI: 10.1016/j.rbmo.2015.08.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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