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Am J Reprod Immunol. 2017 Sep;78(3). doi: 10.1111/aji.12682. Epub 2017 May 3.

Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures.

Author information

1
Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan.
2
Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA.
3
Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
4
Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan.

Abstract

PROBLEM:

We aim to investigate whether the peripheral blood T helper (Th) 1 cell level could predict pregnancy outcome in patients who have experienced repeated implantation failure (RIF, three or more) after ART cycles.

METHOD OF STUDY:

This is a prospective cohort study of total 124 women with RIF who showed elevated Th1/Th2 (CD4+ IFN-γ+ /CD4+ IL-4+ ) cell ratios (≥10.3) and received tacrolimus at Sugiyama Clinic between November 2011 and July 2016. Patients were divided into three groups as per Th1 cell levels: Th1 level of <22.8 as Low; 22.8 to <28.8 as Middle, and 28.8 or greater as High group. The study patients received daily dose of tacrolimus 1-3 mg based on initial Th1/Th2 cell ratio.

RESULTS:

The clinical pregnancy rates of Low, Middle, and High groups were 48.8%, 43.9%, and 33.3%, respectively (P=NS), with tacrolimus treatment. The ongoing pregnancy/delivery rate of Low group (46.3%) was significantly higher than that of High group (21.4%, P<.05). Middle group (34.3%) had higher success rate than High group, albeit without statistical significant.

CONCLUSION:

We confirm our previous report that Th1/Th2 ratio can predict ART outcomes in patients with RIF and immunosuppressant treatment with tacrolimus, and peripheral blood Th1 cell levels were negatively correlated with pregnancy outcome.

KEYWORDS:

Th1/Th2 cell ratio; immunosuppressive treatment; in vitro fertilization; peripheral Th1 cell level; repeated implantation failure; tacrolimus

PMID:
28466977
DOI:
10.1111/aji.12682
[Indexed for MEDLINE]

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