23 feb. 2011 FACTORI IMUNOLOGICI IMPLICAŢI ÎN EŞECUL REPRODUCERII
M. Surcel, R. Micu, Alina Surcel, F. Stamatian
Clinica Obstetrică Ginecologie I, UMF “Iuliu Haţieganu” Cluj Napoca
Rezumat
Randamentul reproductiv al speciei umane este cunoscut ca fiind relativ redus: 25% din embrionii implantati vor fi rezorbiti in intervalul dintre zilele 7-14 de la momentul implantarii, si doar 30% din embrionii conceputi vor reusi sa ajunga la maturitate (1). In privinta avorturilor de prim trimestru, o pondere importanta revine anomaliilor cromozomiale, afectiunilor infectioase sau chiar anomaliilor structurale anatomice (2). Totusi un procent semnificativ (~ 40%), ramane fara nici macar o explicatie minimala deschizand astfel drum pentru un teritoriu patogenetic despre care toata lumea stie ca este foarte important, dar care din pacate este extreme de greu de accesat si de analizat: factorii imunogenetici (3).
In mod formal exista un curent general in a include problemele de natura imunologica in gama afectiunilor ce pot constitui o cauza disctincta de infertilitate sau cel putin de subfertilitate. Cu toate acestea practicienii acorda acestui subiect un loc periferic, preferand sa-l includa in schema de evaluare doar dupa ce au fost epuizate celelalte statii consacrate.
Intr-o buna masura aceasta rezerva are la baza lipsa unor raspunsuri transante la o serie de subiecte aparute in acest context. Problema numarul unu este legata de absenta unor modele patogenetice clare pe care s-ar desfasura o astfel de patologie. Pe un plan oarecum secund se gasesc absenta unor teste fiabile, cu reproductibilitate crescuta precum si modul oarecum intuitiv pe care se bazeaza algoritmii terapeutici, in absenta unor studii care sa delimiteze valori prag in raport cu diferitele optiuni terapeutice.
Abstract – The role of immunological disorders in infertility
Reproductive efficiency of the human species is known to be relatively low: 25% of implanted embryos will be in the interval between the time of implantation 7-14 days, and only 30% of the embryos conceived will be able to reach maturity. In terms of first-trimester abortions, a significant share is chromosomal abnormalities, infectious diseases or structural abnormalities anatomy. However, a significant percentage (~ 40%) remain without even a minimal explanation paving the way for a pathogenetic territory which everyone knows is very important, but unfortunately it is extremely difficult to access and analyze – the imunogenetic factors.
Formally there is a general trend in the nature of the problems include immunological disorders range that may be a cause of infertility or at least subfertility. However given this subject, a practitioner peripheral place, preferring to include it in the evaluation scheme only after having exhausted other dedicated stations.
In good measure this study is based on the lack of answers to a series of trenchant issues arising in this context
Keywords: reproductiv efficiency, immunological factors