Stellenwert der aktiven Immuntherapie bei Kinderwunschpatientinnen

Despite significant improvements in treatment protocols and laboratory techniques the pregnancy rate after methods of assisted reproduction attains a maximum rate of 40% in Germany. The baby-take-home rate lies at a disappointing average rate of 20%. Recurrent implantation failure is becoming a major problem in assisted reproduction therapy. Thus, recent clinical trials have focused on the improvement of therapy outcomes in couples with recurrent failure of implantation. The embryo is considered to be a semiallogenic graft in the endometrium which is not usually affected by the maternal immune system. Balance and interaction of the immune cells at the feto-maternal barrier play a special key role. For this reason new therapeutic approaches have been generated to maintain early pregnancy. The concept of active immunization is based on the theory of a higher HLA compatibility of both partners and a subsequent deregulation of the maternal immune reaction with an adverse impact on the embryo. The immunization of the woman with lymphocytes of her partner was thought to be an improvement in immune identification and stimulation of the maternal immune system to improve the immune reaction on a future pregnancy. Up to now, a clinical benefit of active immunization has not been proven in prospective randomized clinical trials. Therefore, this "therapeutic" approach cannot be regarded as an evidence-based option in assisted reproduction.