Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; and Thomas Jefferson University, Philadelphia, Pennsylvania.
Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; and Thomas Jefferson University, Philadelphia, Pennsylvania.
Fertil Steril. 2017 Jun;107(6):1279-1283. doi: 10.1016/j.fertnstert.2017.04.019. Epub 2017 May 10.
Outcomes in assisted reproduction have seen marked improvement. With increased ability in the embryology laboratory to use extended embryo culture which in turn enables other selective techniques, such as trophectoderm biopsy and comprehensive chromosome screening, the chance of success per embryo transfer is increased. However, even the selection of a euploid blastocyst, which selects out many embryonic factors, does not yield successful implantation and ultimately delivery in all cases. Among the factors that affect implantation failure of apparently reproductively competent embryos, the immune system has been perhaps both the most plausible and the most debated. There are data on T-helper cells, in particular the T1-T2 balance, peripheral and uterine natural killer cells, and autoantibodies, all of which have been shown to have variable effects on implantation. Many investigators have developed and used a wide range of immune tests and treatments aimed at manipulating the milieu to favor implantation. Although it is certain that the immune system plays a role in implantation, our understanding of the physiology, let alone the pathophysiology, remains incomplete. It is imperative that we gain more clear evidence of causes and test and implement treatment paradigms. In the meantime, immune testing or empirical treatment with the use of immune modulators must be approached with caution.
辅助生殖的结局已经有了显著的改善。胚胎实验室的能力不断提高，能够进行更长时间的胚胎培养，从而可以使用其他选择性技术，如滋养外胚层活检和全面染色体筛查，这提高了每个胚胎移植的成功机会。然而，即使选择了非整倍体囊胚，这也排除了许多胚胎因素，但并不能保证在所有情况下都能成功着床和最终分娩。在影响表现出生殖能力的胚胎着床失败的因素中，免疫系统可能是最合理也是最有争议的因素之一。有数据表明 T 辅助细胞，特别是 T1-T2 平衡、外周和子宫自然杀伤细胞以及自身抗体，都对着床有不同的影响。许多研究人员已经开发并使用了广泛的免疫测试和治疗方法，旨在改变微环境以促进着床。尽管可以肯定的是，免疫系统在着床过程中发挥了作用，但我们对其生理学甚至病理生理学的理解仍然不完整。我们必须获得更多关于原因的明确证据，并测试和实施治疗模式。在此期间，必须谨慎地进行免疫测试或使用免疫调节剂进行经验性治疗。
