ROLE OF IMMUNITY IN PREGNANCY

MANAGEMENT OF PCOS RIDA ARIF

OVULATION INDUCTION
CASE
 ROLE OF IMMUNITY IN PREGNANCY

Placenta – Physical Barrier Absence of classical MHC & HLA molecules – does not
activate T cell response
 ROLE OF IMMUNITY IN PREGNANCY
Uterine NK cells are non-
cytotoxic due to decidual
signals. Ligands on invading
trophoblasts suppress their killing
function.
Progesterone – stimulates a Th2
response, reduces inflammatory
cytokines, represses allogenic
responses
Dendritic cells – few in
number so no adaptive T
cell response, ‘tolerogenic
DC’ which preferentially
activate Tregs.
 ROLE OF IMMUNITY IN PREGNANCY
Macrophages –
programmed into
an immune
suppressive state
producing strong
anti-inflammatory
molecules like IL-
10
Regulatory T cells – inhibit
proliferation and cytokine
production in CD4 & CD8 T
cells, suppress B cell
proliferation &
immunoglobulin production,
inhibit cytotoxic function of
NK cells, inhibit maturation
and inflammatory action of
DC and macrophages
MANAGEMENT OF PCOS
MANAGEMENT OF PCOS
OVULATION INDUCTION
CLOMIPHENE
• Selective estrogen receptor modulator
• Binds to and depletes hypothalamic ERs,
blocking negative feedback of estradiol,
increasing GnRH, FSH & LH
• Side Effects: abnormal vaginal
bleeding, breast tenderness, ovarian
enlargement
• Increases the likelihood of multiple
births
LETROZOLE
• Reversible competitive inhibitor of
aromatase
• Reduces estrogen levels stimulating the
hypothalamus to produce more GnRH,
FSH
• Side Effects: Dizziness, Fatigue, Nausea,
Flushing
• Similar efficacy but relatively lower risk
of multiple births
LAPAROSCOPIC OVARIAN DRILLING

• Women with PCOS usually have

ovaries with a thick outer layer. The
ovaries make more testosterone which
can affect the ovulation.
• Ovarian drilling works by breaking
through the thick outer surface and
lowering the amount of testosterone
made by the ovaries.
WEEK 1 QUESTIONS
1. What is the connection between infertility and celiac disease?
2. In the immunobead assay what % of sperm attachment is considered normal?
REFERENCES
• Akhtar, S. (2019). Ovulation and labour inducing drugs.
• Girardi, G. (2019). Immunological aspects of pregnancy.
• Plant, T. (2015). Knobil and Neill's Physiology of Reproduction (Fourth Edition).
4th ed. Academic Press.