Interactive Session - Immunotropic vs. Immune-suppressive Treatment to Enhance Implantation

Date:October 22, 2014

Time:1:15 pm - 2:15 pm

Location:HCC313 - Hawaii Convention Center

Presenters

Joanne Kwak-Kim, M.D., M.P.H. (Chair), The Chicago Medical School at Rosalind Franklin University of Medicine and Science

Zev Williams, M.D. Ph.D., Albert Einstein College of Medicine

George Ndukwe, M.D., Zita West Fertility Center, London

(Debate)

Needs Assessment and Description
Implantation failure is a common cause for repeated assisted reproductive technology (ART) failure and is often associated with immune dysregulation. During this symposium, the role of immunotropism and immune suppression, potential patient populations who are at risk of immune dysregulation, and currently available immunotropic and immune-suppressive treatments to enhance implantation will be discussed. This symposium is targeted toward health-care providers who are closely working with ART and ovulation induction cycles, including reproductive endocrinologists, nurses, and embryologists. 

Learning Objectives
At the conclusion of this session, participants should be able to: 

  1. Define the role of immune suppression to counterbalance immunotropism during implantation and early pregnancy. 
  2. Identify the clinical conditions that lead to immune dysregulation during implantation and early pregnancy. 
  3. Assess pros and cons of currently available immunotropic and immune suppression treatment for repeated implantation failure. 
ACGME Competency
Patient Care 

TEST QUESTION
A 34-year-old woman with autoimmune thyroiditis and rheumatoid arthritis (RA) presents to your office for infertility treatment. She had a total 3 failed in vitro fertilization (IVF) cycles in which a total of 6 good- quality embryos were transferred. Preimplantation genetic diagnosis (PGD) was done in 2 recent IVF cycles and only the genetically normal embryos were transferred. She wants to know what the next step will be. After participating in this session, in my practice I will:
a. Recommend another IVF cycle without any further evaluation, since the cumulative live-birth rate significantly increases even after 3 failed IVF cycles.
b. Recommend another IVF cycle with PGD and increase the number of embryos to be transferred.
c. Investigate possible immune dysregulation, since she has autoimmune conditions and unexplained repeated implantation failures.
d. Provide thyroid supplementation, continue RA treatment during the next IVF cycle, and reassure the patient that no other evaluation or treatment is needed.
e. Not applicable to my area of practice

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