Immunomodulation for unexplained recurrent implantation failure: where are we now?

Area of Science:

• Reproductive immunology
• Embryo implantation immunology

Background:

• Recurrent implantation failure (RIF) affects up to 50% of cases and lacks effective treatments.
• Maternal immune responses critically influence endometrial receptivity and embryo implantation.
• Both under- and over-active immune responses at implantation may cause RIF.

Purpose of the Study:

• To summarize normal and pathological immune responses at implantation.
• To critically appraise current immunomodulatory therapies for RIF.
• To provide clinicians with an overview of therapy efficacy, mechanisms, and side effects.

Main Methods:

• Literature review and critical appraisal of immunomodulatory therapies.
• Summary of immune system roles in endometrial receptivity and implantation.
• Analysis of diagnostic challenges and empirical treatment approaches.

Main Results:

• No validated diagnostic tests exist for immune-mediated RIF, leading to empirical treatments.
• Immunomodulatory strategies aim to promote or suppress inflammation to improve conception rates.
• Personalized medicine approaches are emerging for RIF patient selection.

Conclusions:

• Immune dysfunction is a potential cause of RIF.
• Current immunomodulatory therapies lack robust evidence and are often empirical.
• Further research is needed for validated diagnostics and effective, personalized RIF treatments.