[67] Foxp3 mRNA expression was significantly decreased, but not mRNAs for T-bet (Th1 cells), GATA3 (Th2 cells), and TGF-β, in the endometrium of mid-secretory phase in women with primary unexplained infertility comparing with that in fertile controls.[68] These findings implicate that decreased immune regulatory function may have negative influence on fertility. Recently, Boomsma et al.[69] have demonstrated that cytokines from aspirated endometrial secretion including type 1 and type 2 cytokines, and IL-17 were not significantly different between women with IVF and controls in terms of

pregnancy rate. Several reports have demonstrated that regulatory T cells decreased in the peripheral blood and/or deciduas in women with RPL.[9, 52, 61, 64, 70] In 2004, Sasaki et al.[61] first reported the association between regulatory T cells Cilomilast clinical trial and spontaneous abortion. CD4+ CD25high regulatory

T cells in the peripheral blood and deciduas decreased in spontaneous abortion group as compared to induced selleck chemicals llc abortion group. Furthermore, the percentage of circulating CD4+ CD25+ regulatory T cells significantly increased in early pregnancy comparing to non-pregnant state. However, women with spontaneous abortions did not demonstrate the increase in regulatory T cells during pregnancy. In addition, decidual CD4+ CD25high T cells were significantly lower in women with spontaneous abortion than women undergoing induced abortion. They also observed that decidual and peripheral blood CD4+ CD25+ regulatory T cells were anergic and suppressed BCKDHA the proliferation of CD4+ CD25− T cells via cell contact manner. Arruvito et al.[52] have published a wonderful regulatory T-cell study comparing women with RPL with fertile controls. Opposite to fertile controls, in women with RPL, CD4+ CD25+, CD4+ CD25high, and Foxp3+ regulatory T cells did not show any significant fluctuation during a menstrual cycle. CD4+ CD25high and Foxp3+ T cells regulatory T cells in women with RPL not only significantly decreased as compared to those of controls, but also were as low

as those of postmenopausal women. Moreover, regulatory T cells from women with RPL showed suppressive, but significantly lower in function as compared to those of fertile controls. Lymphocyte immunotherapy (LIT) with paternal or third-party lymphocytes has been demonstrated to increase CD4+ CD25bright T cells.[71] The proportion of these CD4+ CD25bright T cells was higher in women with a successful pregnancy than in women with pregnancy loss after LIT. The presence of intravenous immunoglobulin with human CD4+ CD25+ regulatory T cells in culture significantly increased the expression of Foxp3, TGF-β, and IL-10.[72] These findings suggest that deceased number and defective function of regulatory T cells in women with RPL results in reproductive failure, and immunotherapy may reverse the decreased number and function of regulatory T cells.