Tekrarlayan gebelik kaybı ve implantasyon başarısızlıklarında immünolojik faktörlerin yeri

Canlı bir gebeliğin devamı için yardımcı üreme teknikleri ve tedavi yöntemlerinde gelişmeler sağlansa da, in vitro fertilizasyon (IVF) sonrası tekrarlayan implantasyon başarısızlığı (TİB) ve tekrarlayan gebelik kayıpları (TGK) büyük problem oluşturmaktadır. Son yıllarda yapılan çalışmalarda TİB ve TGK nedeni olarak immunolojik faktörlerin üzerinde durulmaktadır ve bu hasta gruplarında immun sistem hücreleri olan; CD4+ T-helper (Th1, Th2, Th17, Treg) ve periferik natural killer (pNK) ve uterin natural killer (uNK) hücrelerinin aktivitelerinde dengesizlikler gösterilmiştir. Bu nedenle, bu hasta gruplarında başarılı bir implantasyon ve gebelik devamı için glukokortikoidler, intravenöz immünoglobulin ve TNF-α blokerleri gibi immünosüpresan ilaçların kullanımı ve etkinliği araştırılmıştır. Ancak ilaçların etkinliği ile ilgili net bir sonuç elde edilmemiştir. Sonuç olarak, immunoloji ile infertilite ilişkisi aşikar olmasına rağmen, bu konuda daha katedilmesi gereken uzun bir yol vardır.

Anahtar Kelimeler:

infertilite, immünoloji, IVF, tekrarlayan gebelik kaybı, tekrarlayan implantasyon başarısızlıkları

The place of immunological factors in recurrent pregnancy loss and implantation failures

Despite recent advances in assisted reproductive methods and treatments in sustaining fetal viability, recurrent implantation failure (RIF) and recurring pregnancy loss (RPL) still pose significant problems in the context of in vitro fertilization (IVF). Recent studies focused on the role of immunological factors in the etiology of RIF and RPL. They demonstrated that infertile patients might suffer from dysregulated immune system cell activities, including CD4+ T helper (Th1, Th2, Th17, and Tregs), peripheral natural killer (pNK), uterine natural killer (uNK) cells. Researchers have investigated the use and efficacy of immunosuppressant drugs such as glucocorticoids, intravenous immunoglobulin, and TNF-α blockers in achieving successful implantation in infertile women but the efficacy of these treatments remains to be fully established. We conclude that, although the relationship between immunology and infertility is clear, there is still a long way to go to reach a thorough understanding.

Keywords:

Infertility, Immunology, IVF, Recurrent pregnancy loss, Recurrent implantation failures,

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Türk Kadın Sağlığı ve Neonatoloji Dergisi-Cover

Başlangıç: 2019
Yayıncı: Sağlık Bilimleri Üniversitesi Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi

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