Abstract
Around 1 – 3% of all couples who try to have a child are affected by recurrent miscarriage. According to the WHO, recurrent miscarriage is defined as the occurrence of three or more consecutive miscarriages up to the 20th week of pregnancy. There are various causes of recurrent miscarriage; in many cases, the causes remain unclear, with the result that immunological factors are one of the possible causes discussed. For the motherʼs immune system, the embryo represents a semi-allogeneic transplant, as half of the embryoʼs genes are of paternal origin. In place of a conventional immune response, the embryo induces a secondary protection mechanism, which contributes to the successful implantation. When performing immunisation with partner lymphocytes, the patient receives an intradermal injection of her partnerʼs prepared lymphocytes into the volar side of the forearm in order to induce immunomodulation with a consequently increased rate of pregnancy and live birth. A prerequisite for this procedure is that all other possible causes of sterility have been ruled out in advance. Due to the highly heterogeneous nature of the data, a significant benefit as a result of the immunisation cannot yet be clearly proven. However, there are signs that the therapy may be effective when using lymphocytes that have been extracted as short a time beforehand as possible. Overall, the treatment represents a safe, low-risk procedure. Following a detailed informative discussion with the couple regarding the chances of success and following a detailed review of the indication and contraindications, immunisation with partner lymphocytes can be discussed with the couple on a case-by-case basis – provided that all other possible causes of sterility have been ruled out in advance.
Highlights
As a sign of low reproductive efficiency, couples who are trying to have a child may suffer from failure to conceive following multiple embryo transfers
Rapid and unproblematic spontaneous conception may be followed by recurrent loss of the pregnancy within the context of a miscarriage
Recurrent miscarriage is defined as the occurrence of three or more consecutive miscarriages up to the 20th week of pregnancy [1], with the American Society for Reproductive Medicine (ASRM) defining recurrent miscarriage as just two consecutive miscarriages [2]. 1 % of couples is affected by recurrent miscarriage
Summary
As a sign of low reproductive efficiency, couples who are trying to have a child may suffer from failure to conceive following multiple embryo transfers. Two subgroups of T helper cells can be described according to the cytokines they secrete: Type 1 T helper cells are involved in the cellular immune response and release interferon gamma (IFN-γ), interleukin-2 (IL-2) and tumour necrosis factor alpha (TNF-α). Carp et al established a connection between positive detection of antibodies following immunisation and successful pregnancy: 50 % of patients in whom antibodies were detected fell pregnant, but this figure was just 37 % when there were no antibodies detected [33] It is unknown whether the antipaternal HLA antibodies exert a direct effect or whether they are a marker for the successful modulation of the maternal immune system. ▶ Table 1 Current study situation for immunisation with partner lymphocytes: a comparison of three meta-analyses (Wong LF et al, 2014, Liu Z. et al, 2016, Cavalcante MB et al, 2016) with the respective included studies
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