Review
BibTex RIS Cite

Tekrarlayan gebelik kaybı ve implantasyon başarısızlıklarında immünolojik faktörlerin yeri

Year 2020, , 105 - 111, 30.09.2020
https://doi.org/10.46969/ezh.768932

Abstract

Canlı bir gebeliğin devamı için yardımcı üreme teknikleri ve tedavi yöntemlerinde gelişmeler sağlansa da, in vitro fertilizasyon (IVF) sonrası tekrarlayan implantasyon başarısızlığı (TİB) ve tekrarlayan gebelik kayıpları (TGK) büyük problem oluşturmaktadır. Son yıllarda yapılan çalışmalarda TİB ve TGK nedeni olarak immunolojik faktörlerin üzerinde durulmaktadır ve bu hasta gruplarında immun sistem hücreleri olan; CD4+ T-helper (Th1, Th2, Th17, Treg) ve periferik natural killer (pNK) ve uterin natural killer (uNK) hücrelerinin aktivitelerinde dengesizlikler gösterilmiştir. Bu nedenle, bu hasta gruplarında başarılı bir implantasyon ve gebelik devamı için glukokortikoidler, intravenöz immünoglobulin ve TNF-α blokerleri gibi immünosüpresan ilaçların kullanımı ve etkinliği araştırılmıştır. Ancak ilaçların etkinliği ile ilgili net bir sonuç elde edilmemiştir. Sonuç olarak, immunoloji ile infertilite ilişkisi aşikar olmasına rağmen, bu konuda daha katedilmesi gereken uzun bir yol vardır.

Supporting Institution

başkent üniversitesi

References

  • Stanford JB. What is the true prevalence of infertility? Fertil Steril 2013; 99:1201-1202.
  • Dahl M, Hviid TVF. Human leucocyte antigen class Ib molecules in pregnancy success and early pregnancy loss. Hum Reprod Update 2012; 18:92-109.
  • Coughlan C, Ledger W, Wang Q, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014; 28: 14-38.
  • Ehrlich S, Williams PL, Missmer SA, et al. Urinary bisphenol A concentrations and implantation failure among women undergoing in vitro fertilization. Environ Health Perspect 2012; 120: 978-983.
  • Medawar PB. Some immunological and endocrinological problems raised by the evolution of viviparity in vertebrates. Symp Soc Exp Biol 1953; 7: 320-338.
  • Lee SK, Kim CJ, Kim DJ, Kang JH. Immune cells in the female reproductive tract. Immune Netw 2015; 15: 16-26.
  • Garcia-Velasco JA. Introduction: Immunology and assisted reproductive technology in the 21st century. Fertil Steril 2017; 107: 1267-1268.
  • Azargoon A, Mirrasouli Y, Shokrollahi Barough M, Barati M, Kokhaei P. The State of Peripheral Blood Natural Killer Cells and Cytotoxicity in Women with Recurrent Pregnancy Loss and Unexplained Infertility. Int J Fertil Steril 2019; 13:12-17.
  • Tang AW, Alfirevic Z, Quenby S. Natural killer cells and pregnancy outcomes in women with recurrent miscarriage and infertility: a systematic review. Hum Reprod 2011; 26:1971-1980.
  • Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immunol 2002; 2:656-663.
  • Moffett A, Shreeve N. First do no harm: uterine natural killer (NK) cells in assisted reproduction. Hum Reprod 2015; 30:1519-1525.
  • Souza SS, Ferriani RA, Santos CMP, Voltarelli JC. Immunological evaluation of patients with recurrent abortion. J Reprod Immunol 2002; 56:111-121.
  • Björkström NK, Ljunggren HG, Michaëlsson J. Emerging insights into natural killer cells in human peripheral tissues. Nat Rev Immunol 2016; 16:310-320.
  • Kalkunte SS, Mselle TF, Norris WE, Wira CR, Sentman CL, Sharma S. Vascular endothelial growth factor C facilitates immune tolerance and endovascular activity of human uterine NK cells at the maternal-fetal interface. J Immunol 2009; 182:4085-4092.
  • Faas MM, de Vos P. Uterine NK cells and macrophages in pregnancy. Placenta 2017; 56: 44-52.
  • King K, Smith S, Chapman M, Sacks G. Detailed analysis of peripheral blood natural killer (NK) cells in women with recurrent miscarriage. Hum Reprod 2010; 25:52-58.
  • Hosseini S, Zarnani AH, Asgarian-Omran H, et al. Comparative analysis of NK cell subsets in menstrual and peripheral blood of patients with unexplained recurrent spontaneous abortion and fertile subjects. J Reprod Immunol 2014; 103:9-17.
  • Yuan J, Li J, Huang SY, Sun X. Characterization of the subsets of human NKT-like cells and the expression of Th1/Th2 cytokines in patients with unexplained recurrent spontaneous abortion. J Reprod Immunol 2015; 110:81-88.
  • Boyson JE, Aktan I, Barkhuff DA, Chant A. NKT cells at the maternal-fetal interface. Immunol Invest 2008; 37:565-582.
  • Zhou J, Zhao X, Wang Z, Wang J, Sun H, Hu Y. High circulating CD3+CD56+CD16+ natural killer-like T cell levels predict a better IVF treatment outcome. J Reprod Immunol 2013; 97:197-203.
  • Tohma YA, Musabak U, Gunakan E, Akilli H, Onalan G, Zeyneloglu HB. The Role of Analysis of NK Cell Subsets in Peripheral Blood and Uterine Lavage Samples in Evaluation of Patients with Recurrent Implantation Failure. J Gynecol Obstet Hum Reprod 2020; 101793.
  • Donoghue JF, Paiva P, Teh WT, et al. Endometrial uNK cell counts do not predict successful implantation in an IVF population. Hum Reprod 2019; 34:2456-2466.
  • Seshadri S, Sunkara SK. Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Hum Reprod Update 2014; 20: 429-438.
  • Matteo MG, Greco P, Rosenberg P, et al. Normal percentage of CD56bright natural killer cells in young patients with a history of repeated unexplained implantation failure after in vitro fertilization cycles. Fertil Steril 2007; 88:990-993.
  • Giuliani E, Parkin KL, Lessey BA, Young SL, Fazleabas AT. Characterization of uterine NK cells in women with infertility or recurrent pregnancy loss and associated endometriosis. Am J Reprod Immunol 2014; 72:262-269.
  • Kofod L, Lindhard A, Bzorek M, Eriksen JO, Larsen LG, Hviid TVF. Endometrial immune markers are potential predictors of normal fertility and pregnancy after in vitro fertilization. Am J Reprod Immunol 2017; 78: e12684.
  • Daher S, Denardi KAG, Blotta MHSL, et al. Cytokines in recurrent pregnancy loss. J Reprod Immunol 2004; 62:151-157.
  • Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss 3rd JF, Petraglia F. Inflammation and pregnancy. Reprod Sci 2009; 16: 206-215.
  • Salamonsen LA, Hannan NJ, Dimitriadis E. Cytokines and chemokines during human embryo implantation: roles in implantation and early placentation. Semin Reproduct Med 2007; 25:437-444.
  • Comba C, Bastu E, Dural O, et al. Role of inflammatory mediators in patients with recurrent pregnancy loss. Fertil Steril 2015; 104:1467-1474.
  • Liang PY, Diao LH, Huang CY, et al. The pro-inflammatory and anti-inflammatory cytokine profile in peripheral blood of women with recurrent implantation failure. Reprod Biomed Online 2015; 31:823-826.
  • Kalu E, Bhaskaran S, Thum MY, et al. Serial estimation of Th1:th2 cytokines profile in women undergoing in‐vitro fertilization‐embryo transfer. Am J Reprod Immunol 2008; 59:206-211.
  • Kwak‐Kim JYH, Chung‐Bang HS, Ng SC, et al. Increased T helper 1 cytokine responses by circulating T cells are present in women with recurrent pregnancy losses and in infertile women with multiple implantation failures after IVF. Hum Reprod 2003; 18:767-773.
  • Lee SK, Na BJ, Kim JY, et al. Determination of clinical cellular immune markers in women with recurrent pregnancy loss. Am J Reprod Immunol 2013; 70:398-411.
  • Choudhury SR, Knapp LA. Human reproductive failure I: immunological factors. Hum Reprod Update 2001; 7:113-134.
  • Matter TF, Sharif F A. HLA-G and HLA-E Gene polymorphisms in idiopathic recurrent spontaneous abortion women in Gaza strip-Palestine. Int J Reprod Contracept Obstet Gynecol 2013; 2:277-283.
  • Afkhami F, Khaniani MS, Farzadi L, Paknejad Z, Derakhshan SM. The HLA-G 14-bp insertion/deletion polymorphism in recurrent spontaneous abortion among Iranian women. Iran J Allergy Asthma Immunol 2014; 13:364-369.
  • Gregori S, Amodio G, Quattrone F, Panina-Bordignon P. HLA-G Orchestrates the Early Interaction of Human Trophoblasts with the Maternal Niche. Front Immunol 2015; 6:128.
  • Moffett A, Chazara O, Colucci F, Johnson MH. Variation of maternal KIR and fetal HLA-C genes in reproductive failure: too early for clinical intervention. Reprod Biomed Online 2016; 33:763-769.
  • Lynge Nilsson L, Djurisic S, Hviid TV. Controlling the Immunological Crosstalk during Conception and Pregnancy: HLA-G in Reproduction. Front Immunol 2014; 5:198.
  • Hviid MM, Macklon N. Immune modulation treatments—where is the evidence? Fertil Steril 2017; 107:1284-1293.
  • Li J, Chen Y, Liu C, Hu Y, Li L. Intravenous immunoglobulin treatment for repeated IVF/ICSI failure and unexplained infertility: a systematic review and a meta‐analysis. Am J Reprod Immunol 2013; 70:434-447.
  • Wong LF, Porter TF, Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev. 2014; 2014(10):CD000112.
  • Tang AW, Alfirevic Z, Turner MA, Drury JA, Small R, Quenby S. A feasibility trial of screening women with idiopathic recurrent miscarriage for high uterine natural killer cell density and randomizing to prednisolone or placebo when pregnant. Hum Reprod 2013; 28:1743-1752.
  • Boomsma CM, Keay SD, Macklon NS. Peri‐implantation glucocorticoid administration for assisted reproductive technology cycles. Cochrane Database Syst Rev 2012; (6):CD005996.
  • Fawzy M, Shokeir T, El-Tatongy M, Warda O, El-Refaiey AAA, Mosbah A. Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized placebo-controlled study. Arch Gynecol Obstet 2008; 278:33-38.
  • Gomaa MF, Elkholy AG, El-Said MM, Abdel-Salam NE. Combined oral prednisolone and heparin versus heparin: the effect on peripheral NK cells and clinical outcome in patients with unexplained recurrent miscarriage. A double-blind placebo randomized controlled trial. Arch Gynecol Obstet 2014; 290:757-762.
  • Winger EE, Reed JL, Ashoush S, Ahuja S, El‐Toukhy T, Taranissi M. Treatment with adalimumab (Humira®) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF. Am J Reprod Immunol 2009; 61:113-120.
  • Winger EE, Reed JL, Ashoush S, El‐Toukhy T, Ahuja S, Taranissi M. Degree of TNF‐α/IL-‐10 cytokine elevation correlates with IVF success rates in women undergoing treatment with adalimumab (Humira) and IVIG. Am J Reprod Immunol 2011; 65:610-618.
  • Thomson AW, Bonham CA, Zeevi A. Mode of action of tacrolimus (FK506): molecular and cellular mechanisms. Ther Drug Monit 1995; 17:584-591.
  • Nakagawa K, Kwak‐Kim J, Ota K, Kuroda K, Hisano M, Sugiyama R, Yamaguchi K. Immunosuppression with tacrolimus improved reproductive outcome of women with repeated implantation failure and elevated peripheral blood TH1/TH2 cell ratios. Am J Reprod Immunol 2015; 73:353-361.
  • Nakagawa K, Kwak‐Kim J, Kuroda K, Sugiyama R,Yamaguchi K. Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures. Am J Reprod Immunol 2017; 78:e12682.
  • Kainz A, Harabacz I, Cowlrick IS, Gadgil S, Hagiwara D. Analysis of 100 pregnancy outcomes in women treated systemically with tacrolimus. Transpl Int 2000; 13 Suppl 1:S299-300.

The place of immunological factors in recurrent pregnancy loss and implantation failures

Year 2020, , 105 - 111, 30.09.2020
https://doi.org/10.46969/ezh.768932

Abstract

Despite recent advances in assisted reproductive methods and treatments in sustaining fetal viability, recurrent implantation failure (RIF) and recurring pregnancy loss (RPL) still pose significant problems in the context of in vitro fertilization (IVF). Recent studies focused on the role of immunological factors in the etiology of RIF and RPL. They demonstrated that infertile patients might suffer from dysregulated immune system cell activities, including CD4+ T helper (Th1, Th2, Th17, and Tregs), peripheral natural killer (pNK), uterine natural killer (uNK) cells. Researchers have investigated the use and efficacy of immunosuppressant drugs such as glucocorticoids, intravenous immunoglobulin, and TNF-α blockers in achieving successful implantation in infertile women but the efficacy of these treatments remains to be fully established. We conclude that, although the relationship between immunology and infertility is clear, there is still a long way to go to reach a thorough understanding.

References

  • Stanford JB. What is the true prevalence of infertility? Fertil Steril 2013; 99:1201-1202.
  • Dahl M, Hviid TVF. Human leucocyte antigen class Ib molecules in pregnancy success and early pregnancy loss. Hum Reprod Update 2012; 18:92-109.
  • Coughlan C, Ledger W, Wang Q, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014; 28: 14-38.
  • Ehrlich S, Williams PL, Missmer SA, et al. Urinary bisphenol A concentrations and implantation failure among women undergoing in vitro fertilization. Environ Health Perspect 2012; 120: 978-983.
  • Medawar PB. Some immunological and endocrinological problems raised by the evolution of viviparity in vertebrates. Symp Soc Exp Biol 1953; 7: 320-338.
  • Lee SK, Kim CJ, Kim DJ, Kang JH. Immune cells in the female reproductive tract. Immune Netw 2015; 15: 16-26.
  • Garcia-Velasco JA. Introduction: Immunology and assisted reproductive technology in the 21st century. Fertil Steril 2017; 107: 1267-1268.
  • Azargoon A, Mirrasouli Y, Shokrollahi Barough M, Barati M, Kokhaei P. The State of Peripheral Blood Natural Killer Cells and Cytotoxicity in Women with Recurrent Pregnancy Loss and Unexplained Infertility. Int J Fertil Steril 2019; 13:12-17.
  • Tang AW, Alfirevic Z, Quenby S. Natural killer cells and pregnancy outcomes in women with recurrent miscarriage and infertility: a systematic review. Hum Reprod 2011; 26:1971-1980.
  • Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immunol 2002; 2:656-663.
  • Moffett A, Shreeve N. First do no harm: uterine natural killer (NK) cells in assisted reproduction. Hum Reprod 2015; 30:1519-1525.
  • Souza SS, Ferriani RA, Santos CMP, Voltarelli JC. Immunological evaluation of patients with recurrent abortion. J Reprod Immunol 2002; 56:111-121.
  • Björkström NK, Ljunggren HG, Michaëlsson J. Emerging insights into natural killer cells in human peripheral tissues. Nat Rev Immunol 2016; 16:310-320.
  • Kalkunte SS, Mselle TF, Norris WE, Wira CR, Sentman CL, Sharma S. Vascular endothelial growth factor C facilitates immune tolerance and endovascular activity of human uterine NK cells at the maternal-fetal interface. J Immunol 2009; 182:4085-4092.
  • Faas MM, de Vos P. Uterine NK cells and macrophages in pregnancy. Placenta 2017; 56: 44-52.
  • King K, Smith S, Chapman M, Sacks G. Detailed analysis of peripheral blood natural killer (NK) cells in women with recurrent miscarriage. Hum Reprod 2010; 25:52-58.
  • Hosseini S, Zarnani AH, Asgarian-Omran H, et al. Comparative analysis of NK cell subsets in menstrual and peripheral blood of patients with unexplained recurrent spontaneous abortion and fertile subjects. J Reprod Immunol 2014; 103:9-17.
  • Yuan J, Li J, Huang SY, Sun X. Characterization of the subsets of human NKT-like cells and the expression of Th1/Th2 cytokines in patients with unexplained recurrent spontaneous abortion. J Reprod Immunol 2015; 110:81-88.
  • Boyson JE, Aktan I, Barkhuff DA, Chant A. NKT cells at the maternal-fetal interface. Immunol Invest 2008; 37:565-582.
  • Zhou J, Zhao X, Wang Z, Wang J, Sun H, Hu Y. High circulating CD3+CD56+CD16+ natural killer-like T cell levels predict a better IVF treatment outcome. J Reprod Immunol 2013; 97:197-203.
  • Tohma YA, Musabak U, Gunakan E, Akilli H, Onalan G, Zeyneloglu HB. The Role of Analysis of NK Cell Subsets in Peripheral Blood and Uterine Lavage Samples in Evaluation of Patients with Recurrent Implantation Failure. J Gynecol Obstet Hum Reprod 2020; 101793.
  • Donoghue JF, Paiva P, Teh WT, et al. Endometrial uNK cell counts do not predict successful implantation in an IVF population. Hum Reprod 2019; 34:2456-2466.
  • Seshadri S, Sunkara SK. Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Hum Reprod Update 2014; 20: 429-438.
  • Matteo MG, Greco P, Rosenberg P, et al. Normal percentage of CD56bright natural killer cells in young patients with a history of repeated unexplained implantation failure after in vitro fertilization cycles. Fertil Steril 2007; 88:990-993.
  • Giuliani E, Parkin KL, Lessey BA, Young SL, Fazleabas AT. Characterization of uterine NK cells in women with infertility or recurrent pregnancy loss and associated endometriosis. Am J Reprod Immunol 2014; 72:262-269.
  • Kofod L, Lindhard A, Bzorek M, Eriksen JO, Larsen LG, Hviid TVF. Endometrial immune markers are potential predictors of normal fertility and pregnancy after in vitro fertilization. Am J Reprod Immunol 2017; 78: e12684.
  • Daher S, Denardi KAG, Blotta MHSL, et al. Cytokines in recurrent pregnancy loss. J Reprod Immunol 2004; 62:151-157.
  • Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss 3rd JF, Petraglia F. Inflammation and pregnancy. Reprod Sci 2009; 16: 206-215.
  • Salamonsen LA, Hannan NJ, Dimitriadis E. Cytokines and chemokines during human embryo implantation: roles in implantation and early placentation. Semin Reproduct Med 2007; 25:437-444.
  • Comba C, Bastu E, Dural O, et al. Role of inflammatory mediators in patients with recurrent pregnancy loss. Fertil Steril 2015; 104:1467-1474.
  • Liang PY, Diao LH, Huang CY, et al. The pro-inflammatory and anti-inflammatory cytokine profile in peripheral blood of women with recurrent implantation failure. Reprod Biomed Online 2015; 31:823-826.
  • Kalu E, Bhaskaran S, Thum MY, et al. Serial estimation of Th1:th2 cytokines profile in women undergoing in‐vitro fertilization‐embryo transfer. Am J Reprod Immunol 2008; 59:206-211.
  • Kwak‐Kim JYH, Chung‐Bang HS, Ng SC, et al. Increased T helper 1 cytokine responses by circulating T cells are present in women with recurrent pregnancy losses and in infertile women with multiple implantation failures after IVF. Hum Reprod 2003; 18:767-773.
  • Lee SK, Na BJ, Kim JY, et al. Determination of clinical cellular immune markers in women with recurrent pregnancy loss. Am J Reprod Immunol 2013; 70:398-411.
  • Choudhury SR, Knapp LA. Human reproductive failure I: immunological factors. Hum Reprod Update 2001; 7:113-134.
  • Matter TF, Sharif F A. HLA-G and HLA-E Gene polymorphisms in idiopathic recurrent spontaneous abortion women in Gaza strip-Palestine. Int J Reprod Contracept Obstet Gynecol 2013; 2:277-283.
  • Afkhami F, Khaniani MS, Farzadi L, Paknejad Z, Derakhshan SM. The HLA-G 14-bp insertion/deletion polymorphism in recurrent spontaneous abortion among Iranian women. Iran J Allergy Asthma Immunol 2014; 13:364-369.
  • Gregori S, Amodio G, Quattrone F, Panina-Bordignon P. HLA-G Orchestrates the Early Interaction of Human Trophoblasts with the Maternal Niche. Front Immunol 2015; 6:128.
  • Moffett A, Chazara O, Colucci F, Johnson MH. Variation of maternal KIR and fetal HLA-C genes in reproductive failure: too early for clinical intervention. Reprod Biomed Online 2016; 33:763-769.
  • Lynge Nilsson L, Djurisic S, Hviid TV. Controlling the Immunological Crosstalk during Conception and Pregnancy: HLA-G in Reproduction. Front Immunol 2014; 5:198.
  • Hviid MM, Macklon N. Immune modulation treatments—where is the evidence? Fertil Steril 2017; 107:1284-1293.
  • Li J, Chen Y, Liu C, Hu Y, Li L. Intravenous immunoglobulin treatment for repeated IVF/ICSI failure and unexplained infertility: a systematic review and a meta‐analysis. Am J Reprod Immunol 2013; 70:434-447.
  • Wong LF, Porter TF, Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev. 2014; 2014(10):CD000112.
  • Tang AW, Alfirevic Z, Turner MA, Drury JA, Small R, Quenby S. A feasibility trial of screening women with idiopathic recurrent miscarriage for high uterine natural killer cell density and randomizing to prednisolone or placebo when pregnant. Hum Reprod 2013; 28:1743-1752.
  • Boomsma CM, Keay SD, Macklon NS. Peri‐implantation glucocorticoid administration for assisted reproductive technology cycles. Cochrane Database Syst Rev 2012; (6):CD005996.
  • Fawzy M, Shokeir T, El-Tatongy M, Warda O, El-Refaiey AAA, Mosbah A. Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized placebo-controlled study. Arch Gynecol Obstet 2008; 278:33-38.
  • Gomaa MF, Elkholy AG, El-Said MM, Abdel-Salam NE. Combined oral prednisolone and heparin versus heparin: the effect on peripheral NK cells and clinical outcome in patients with unexplained recurrent miscarriage. A double-blind placebo randomized controlled trial. Arch Gynecol Obstet 2014; 290:757-762.
  • Winger EE, Reed JL, Ashoush S, Ahuja S, El‐Toukhy T, Taranissi M. Treatment with adalimumab (Humira®) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF. Am J Reprod Immunol 2009; 61:113-120.
  • Winger EE, Reed JL, Ashoush S, El‐Toukhy T, Ahuja S, Taranissi M. Degree of TNF‐α/IL-‐10 cytokine elevation correlates with IVF success rates in women undergoing treatment with adalimumab (Humira) and IVIG. Am J Reprod Immunol 2011; 65:610-618.
  • Thomson AW, Bonham CA, Zeevi A. Mode of action of tacrolimus (FK506): molecular and cellular mechanisms. Ther Drug Monit 1995; 17:584-591.
  • Nakagawa K, Kwak‐Kim J, Ota K, Kuroda K, Hisano M, Sugiyama R, Yamaguchi K. Immunosuppression with tacrolimus improved reproductive outcome of women with repeated implantation failure and elevated peripheral blood TH1/TH2 cell ratios. Am J Reprod Immunol 2015; 73:353-361.
  • Nakagawa K, Kwak‐Kim J, Kuroda K, Sugiyama R,Yamaguchi K. Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures. Am J Reprod Immunol 2017; 78:e12682.
  • Kainz A, Harabacz I, Cowlrick IS, Gadgil S, Hagiwara D. Analysis of 100 pregnancy outcomes in women treated systemically with tacrolimus. Transpl Int 2000; 13 Suppl 1:S299-300.
There are 53 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Review Article
Authors

Eser Çolak

Hulusi Zeyneloglu This is me

Publication Date September 30, 2020
Acceptance Date September 28, 2020
Published in Issue Year 2020

Cite

APA Çolak, E., & Zeyneloglu, H. (2020). The place of immunological factors in recurrent pregnancy loss and implantation failures. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 2(3), 105-111. https://doi.org/10.46969/ezh.768932
AMA Çolak E, Zeyneloglu H. The place of immunological factors in recurrent pregnancy loss and implantation failures. Türk Kadın Sağlığı ve Neonatoloji Dergisi. September 2020;2(3):105-111. doi:10.46969/ezh.768932
Chicago Çolak, Eser, and Hulusi Zeyneloglu. “The Place of Immunological Factors in Recurrent Pregnancy Loss and Implantation Failures”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 2, no. 3 (September 2020): 105-11. https://doi.org/10.46969/ezh.768932.
EndNote Çolak E, Zeyneloglu H (September 1, 2020) The place of immunological factors in recurrent pregnancy loss and implantation failures. Türk Kadın Sağlığı ve Neonatoloji Dergisi 2 3 105–111.
IEEE E. Çolak and H. Zeyneloglu, “The place of immunological factors in recurrent pregnancy loss and implantation failures”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 2, no. 3, pp. 105–111, 2020, doi: 10.46969/ezh.768932.
ISNAD Çolak, Eser - Zeyneloglu, Hulusi. “The Place of Immunological Factors in Recurrent Pregnancy Loss and Implantation Failures”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 2/3 (September 2020), 105-111. https://doi.org/10.46969/ezh.768932.
JAMA Çolak E, Zeyneloglu H. The place of immunological factors in recurrent pregnancy loss and implantation failures. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2020;2:105–111.
MLA Çolak, Eser and Hulusi Zeyneloglu. “The Place of Immunological Factors in Recurrent Pregnancy Loss and Implantation Failures”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 2, no. 3, 2020, pp. 105-11, doi:10.46969/ezh.768932.
Vancouver Çolak E, Zeyneloglu H. The place of immunological factors in recurrent pregnancy loss and implantation failures. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2020;2(3):105-11.