Immuntherapie zur Abortprophylaxe und zur Verbesserung der Implantation bei der extrakorporalen Befruchtung

Zusammenfassung

Ähnlich wie bei Frauen mit wiederholten Aborten, finden sich auch bei Frauen mit wiederholt ausbleibender Implantation nach In-vitro-Fertilisation und Embryotransfer (IVF/ET), definiert als mindestens drei Transfers von morphologisch guter Qualität, eine gehäufte Prävalenz von organspezifischen und nicht-organspezifischen Antikörpern. Es ist nicht bekannt, ob diese Autoantikörper eine kausale Rolle bei der Verhinderung der Implantation spielen oder lediglich eine zugrunde liegende systematische Störung reflektieren. An therapeutischen Ansätzen zur Verbesserung der Implantation nach IVF/ET wurden im Rahmen von Fallserien Prednisolon (10 mg/Tag), Heparin und Aspirin (80-100 mg/Tag) auch in Verbindung mit Immunglobulinen sowie die aktive Immuntherapie mit paternalen Lymphozyten versucht. Alle diese Interventionen sind im Rahmen der IVF/ET derzeit als experimentell zu bewerten. Kontrollierte, randomisierte und prospektive Therapiestudien an einer genügend großen Zahl von Paaren wurden zu dieser Fragestellung bislang nicht durchgeführt.

Immunotherapy for the prevention of miscarriage and for the support of implantation after in-vitro fertilization

Summary

In women with a history of recurrent in-vitro fertilization failure (at least three transfers of good quality embryos), there is an increased prevalence of organo-specific and not organo-specific autoantibodies, similar to women with a history of recurrent miscarriage. It is still unknown whether these autoantibodies are causally related to the failure of implantation or merely reflect an underlying systemic disorder. Several therapeutic intervention for the improvement of implantation after in-vitro fertilization and embryo transfer have been tried, including prednisolone (10 mg/d), heparin and aspirin (80-100 mg/d) alone or in combination with immunoglobulins and active immunotherapy using partner's leukocytes. At present, these interventions in combination with IVF should be regarded as experimental, as controlled, randomized and prospective trials in a large number of couples are still lacking.

Schlüsselwörter

Wiederholte Aborte - In-vitro-Fertilisation - Implantation - Autoantikörper - Immuntherapie

Key words

Recurrent miscarriage - in vitro fertilization - implantation - autoantibodies - immunotherapy

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