Immunology of Recurrent Pregnancy Loss and Implantation Failure

Joanne Kwak-Kim Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA Corresponding author at: Reproductive Medicine, Department of Obstetrics and Gynecology, Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, 830 West End Court, Suite 400, Vernon Hills, IL, 60061, USA. Fax: +?1 847 327 6129 Dr. Kwak has the highest scholarly output on this subject. A pioneer in the field of Reproductive Immunology, Dr. Kwak-Kim has devoted more than 25 years of her career to Reproductive Immunology research and continues to do so. She is focusing her research on unravelling the role of the immune system in pregnancy and pregnancy loss and developing treatment plans that help women maintain successful pregnancies. While attempting pregnancy, Dr Kwak-Kim and her staff co-manage patients along with their reproductive endocrinologist or primary gynaecologist. Once pregnancy occurs, co-management continues with their obstetricians or high-risk obstetricians.

Section 1. Introduction

Section 2. RPL of immune etiologies 1. Autoimmune etiologies focusing antiphospholipid antibody 2. ANA related conditions 3. Celiac disease and RPL/RIF 4. NK cell pathology and RF; NK cell level, NK cell cytotoxicity and KIR/HLA-C 5. Th cell pathology and RPL; TH1/Th2, Treg/Th17, and others 6. B cell pathology and RPL; B cell 7. Mast cell pathology and RPL 8. Endometrial pathology and RPL 9. Infectious diseases that can flare immune responses; Lyme’s disease, COVID-19, etc. 10. Thrombophilic pathology and RPL 11. Alloimmune conditions (NAIT, Rh sensitization)

Section 3. Repeated implantation failures of immune etiologies 12. Autoimmune etiologies focusing antiphospholipid antibody 13. NK cell pathology and RIF 14. Th cell pathology and RIF 15. B cell pathology and RIF; Allergy, Asthma and infertility 16. Endometrial pathology and RIF 17. Thrombophilic condition and RIF

Section 4. Systemic immune etiologies for RIF/RPL 18. Ovarian pathology and RIF/RPL 19. Endometriosis and RIF/RPL 20. ART and RIF/RPL 21. Hormonal/metabolic diseases that can cause proinflammatory condition: autoimmune thyroiditis, PCOS, DM, vitamin D deficiency, and homocysteinemia 22. Stress induced immune flare in women with RF

Section 5. Treatment modalities 23. Immunotherapy 24. Anti-coagulant 25. Hormonal/metabolic 26. Reproductive supplements 27. Vitamins: Vitamin C, D, E, Folic acid, vitamin B12, selenium, zinc 28. Ovulation boost; DHEA, CoQ10, myoinositol, acaiberry, MACA, ALA, NAC, melatonin 29. Anti-inflammatory- LDN (low dose naltrexone), curcumin 30. Chinese medicine: Zishen Yutai pill, Shoutai pill