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Journal of Assisted Reproduction and Genetics

, Volume 34, Issue 4, pp 425–430 | Cite as

Redirecting reproductive immunology research toward pregnancy as a period of temporary immune tolerance

  • Norbert Gleicher
  • Vitaly A. Kushnir
  • David H Barad
Commentary

Abstract

Referring to two recent publications, we here propose that clinical reproductive immunology has for decades stagnated because reproductive medicine, including assisted reproduction (AR), has failed to accept embryo implantation as an immune system-driven process, dependent on establishment of maternal tolerance toward the implanting fetal semi-allograft (and complete allograft in cases of oocyte donation). Pregnancy represents a biologically unique period of temporary (to the period of gestation restricted) tolerance, otherwise only known in association with parasitic infections. Rather than investigating the immune pathways necessary to induce this rather unique state of tolerance toward the rapidly growing parasitic antigen load of the fetus, the field, instead, concentrated on irrelevant secondary immune phenomena (i.e., “immunological noise”). It, therefore, does not surprise that interesting recent research, offering new potential insights into maternal tolerance during pregnancy, was mostly published outside of the field of reproductive medicine. This research offers evidence for existence of inducible maternal tolerance pathways with the ability of improving maternal fecundity and, potentially, reducing such late pregnancy complications as premature labor and preeclampsia/eclampsia due to premature abatement of maternal tolerance. Increasing evidence also suggests that tolerance-inducing immune pathways are similar in successful pregnancy, successful organ transplantation and, likely also in the tolerance of “self” (i.e., prevention of autoimmunity). Identifying and isolating these pathways, therefore, may greatly benefit all three of these clinical areas, and research in reproductive immunology should be accordingly redirected.

Keywords

Assisted reproduction Immune suppression Tolerance Immune pathways Implantation Implantation failure Pregnancy loss 

Notes

Authors’ contributions

NG conceived the concept for this manuscript and wrote the first draft. VAK and DHB contributed to revisions of the manuscript. All authors approved of the final manuscript.

Compliance with ethical standards

Funding

No external funds were used in support of this manuscript.

Conflict of interest

NG, and DHB, are co-inventors on a number of pending and already awarded US patents claiming therapeutic benefits from androgen supplementation in women with low functional ovarian reserve (LFOR) and relating to the FMR1 gene in a diagnostic function in female fertility. Both receive royalties from Fertility Nutraceuticals, LLC, in which NG also holds shares. NG, DHB, and VAK also are co-inventors on three pending AMH-related patent applications. They report no conflicts with the reported manuscript.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Norbert Gleicher
    • 1
    • 2
    • 3
    • 4
  • Vitaly A. Kushnir
    • 1
    • 5
  • David H Barad
    • 1
    • 2
  1. 1.The Center for Human ReproductionNew YorkUSA
  2. 2.Foundation for Reproductive MedicineNew YorkUSA
  3. 3.Laboratory of Stem Cell Biology and Molecular EmbryologyThe Rockefeller UniversityNew YorkUSA
  4. 4.Department of Obstetrics and GynecologyUniversity of Vienna School of MedicineViennaAustria
  5. 5.Department of Obstetrics and GynecologyWake Forest UniversityWinston SalemUSA

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