IMMUNOBIOLOGICAL MECHANISMS AND MANAGEMENT OF RECURRENT PREGNANCY LOSS (REVIEW)

Recurrent pregnancy loss (RPL) is a profound personal tragedy for couples. It represent not only reproductive and social problems, but still big clinical challenge to their gynecologists worldwide. After even a thorough evaluation 50% of cases still remain unexplained, a large percentage of which is attributable to immunological causes. The aim of this review is to outline the current understanding of immunological pathways of RPL and highlight the modern approach to the diagnostics and treatment of this disorder. There is a growing interest worldwide in understanding the potential role of altered immunological mechanisms during pregnancy towards the reproductive outcome. Significant advances in molecular immunobiology have clarified many immune parameters of the unique feto-maternal relationship, however, due to the complexity and diversity of immunologic interactions between mother and fetus, many questions still remain unanswered. There is a lack of high quality literature regarding this issue and often it is frustratingly inconsistent. Intensive research is being carried out to detect reliable, informative immune markers for the prediction of subsequent miscarriage risk. Furthermore, there is an increasing demand from desperate couples with RPL for an "immune cell tests" and "immune treatments", even though there are not evidences-based diagnostic and treatment modalities to offer them and results of different studies are contradictory. Despite the extensive research in reproductive immunology, exact fine pathophysiological mechanisms, investigations and treatment of RPL is poorly understood. Therefore, constant updating of information and swapping scientific approaches around this topic would provide better insights into the immunological mechanisms underlying RPL.