Immune responses play an important role in various reproductive processes, including ovulation, menstruation and parturition. Clearly, during pregnancy, when the mother must accept a semi-allogeneic fetus, immune responses also play a very important role. This was first recognized by Medawar in 1953, when the concept of the fetal allograft was presented in order to explain the immunological relationship between mother and fetus. Since then, the immunology of pregnancy has been the leading subject within reproductive immunology research. Yet, the question of why the semi-allogeneic fetus is not rejected by the mother remains unresolved. The present review provides an update of current knowledge on the subject of the so-called 'immunological paradox of pregnancy'.

The decline in fecundity with female age is a well-known phenomenon for clinicians dealing with subfertility patients. Diminishing ovarian reserve seems to be the reason for declining fecundity. Since age is only a rough estimate of ovarian reserve, many tests have been developed to predict ovarian reserve more precisely. This review focuses on these ovarian reserve tests and their clinical role in predicting response to ovarian stimulation and pregnancy chances. According to our analysis, the clomiphene citrate challenge test has the strongest correlation in predicting ovarian reserve, and is the only test that is validated in the general infertility population. The antral follicle count by ultrasound is promising and may offer clinical use. It is not known whether a combination of tests can provide more accurate information of ovarian reserve. It is not yet clear to which extent the results of ovarian reserve tests can be incorporated into the available prognostic models. There is a need for prospective cohort studies that focus on prognostic factors among which are the results of ovarian reserve tests. Only then can the qualitative and quantitative relevance of ovarian reserve testing in the context of the prognosis for couples with subfertility be established.

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Pregnancy rates after IVF with minimal, late follicular phase stimulation are encouraging. Considering the low-risk and patient-friendly nature of this protocol, it may be a feasible alternative to IVF with ovarian hyperstimulation.

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