Fertility and sterility · 2020
Parental human leukocyte antigen-C allotypes are predictive of live birth rate and risk of poor placentation in assisted reproductive treatment.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Alecsandru Diana, Barrio Ana, Garrido Nicolás, Aparicio Pilar, Pellicer Antonio, Moffett Ashley, García-Velasco Juan A
Аннотация
OBJECTIVE: To study the pregnancy, miscarriages, and live birth rates (LBRs) according to maternal killer cell immunoglobulin-like receptor (KIR) genes expressed by uterine natural killer cells and paternal or oocyte donor human leukocyte antigen-C (HLA-C) genes expressed by trophoblast cells in patients with recurrent reproductive failure.
DESIGN: Prospective observational cohort study.
SETTING: Private infertility center.
PATIENT(S): Participants included 204 women with recurrent miscarriage or recurrent implantation failure.
INTERVENTION(S): The KIR and HLA-C genotypes of all women and HLA-C of their partners, gamete donors, miscarriage tissue, and babies were analyzed.
MAIN OUTCOME MEASURE(S): All clinical variables (pregnancy, miscarriage, and LBRs) were analyzed and categorized based on KIR, oocyte origin, and single embryo transfer (SET)/double embryo transfer (DET).
RESULT(S): A higher miscarriage rate was observed after DETs in KIR AA mothers (47.8% egg donation and 37.5% in vitro fertilization [IVF]) compared with KIR AB (10.5% egg donation and 12.5% IVF) or KIR BB (6.7% egg donation and 0% IVF). A significantly decreased LBR was observed after DETs with oocyte donation in KIR AA patients (4.3%) compared with KIR AB (26.3%) or BB (46.7%). The LBR decreased significantly as the fetal HLA-C2 load increased in KIR AA women.
CONCLUSION(S): Elective SET improves the reproductive outcomes compared with DET. An increased embryo HLA-C2 load has a negative impact on the LBR in KIR AA patients. The selection of HLA-C1 over HLA-C2 donors could have a positive impact on the LBR in KIR AA patients.
CLINICAL TRIAL REGISTRATION NUMBER: NCT04052438.
DESIGN: Prospective observational cohort study.
SETTING: Private infertility center.
PATIENT(S): Participants included 204 women with recurrent miscarriage or recurrent implantation failure.
INTERVENTION(S): The KIR and HLA-C genotypes of all women and HLA-C of their partners, gamete donors, miscarriage tissue, and babies were analyzed.
MAIN OUTCOME MEASURE(S): All clinical variables (pregnancy, miscarriage, and LBRs) were analyzed and categorized based on KIR, oocyte origin, and single embryo transfer (SET)/double embryo transfer (DET).
RESULT(S): A higher miscarriage rate was observed after DETs in KIR AA mothers (47.8% egg donation and 37.5% in vitro fertilization [IVF]) compared with KIR AB (10.5% egg donation and 12.5% IVF) or KIR BB (6.7% egg donation and 0% IVF). A significantly decreased LBR was observed after DETs with oocyte donation in KIR AA patients (4.3%) compared with KIR AB (26.3%) or BB (46.7%). The LBR decreased significantly as the fetal HLA-C2 load increased in KIR AA women.
CONCLUSION(S): Elective SET improves the reproductive outcomes compared with DET. An increased embryo HLA-C2 load has a negative impact on the LBR in KIR AA patients. The selection of HLA-C1 over HLA-C2 donors could have a positive impact on the LBR in KIR AA patients.
CLINICAL TRIAL REGISTRATION NUMBER: NCT04052438.