Our results demonstrate the existence of an endometrial microbiota that is highly stable during the acquisition of endometrial receptivity. However, pathological modification of its profile is associated with poor reproductive outcomes for in vitro fertilization patients. This finding adds a novel microbiological dimension to the reproductive process.

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The monthly remodeling, shedding, and regeneration of the endometrium defining the human menstrual cycle is driven by gene expression changes in the underlying tissue hierarchy. Significant heterogeneity exists among cell types in the endometrium, such that multiple cell types vary dramatically in state through a monthly cycle and undergo various forms of differentiation at rapid rates. Histologic analysis and whole-tissue transcriptomic profiling have defined a specific molecular state as the optimal timing of the window of implantation (WOI) for in vitro fertilization transfer.This single-cell transcriptomic analysis aimed to characterize the transcriptomic transformation of human endometrium at single-cell resolution across the menstrual cycle, including at the WOI. Endometrial biopsies were collected from 19 healthy ovum donors between 4 and 27 days following menses, and single cells were captured and complementary DNA was generated using Fluidigm C1 medium chips. Six cell types were identified across the menstrual cycle: stromal fibroblast, endothelium, macrophage, lymphocyte, ciliated epithelium, and unciliated epithelium.Endometrial transformation was analyzed by within-cell type t-SNE using whole-transcriptome data from unciliated epithelia and stromal fibroblasts, the 2 major contributing cell types to endometrial transformation. This revealed 4 major, time-associated phases of both cell types. Among unciliated epithelia, single-cell gene dynamics were relatively continuous across phases 1 to 3 until an abrupt activation of genes consistently reported in whole-tissue transcriptomic data sets as overexpressed in the WOI marked entrance into phase 4. Among stromal fibroblasts, the WOI was characterized by widespread decidualization that became gradually upregulated through phase progression. Likewise, the WOI closed with more gradual transition dynamics in both cell types.The traditional definition of endometrial phases, consisting of the proliferative and secretory phases, correlated with the 4 phases identified here through single-cell analysis. Cell-cycling was elevated in phases 1 and 2 and ceased in later phases, suggesting the transition from proliferative to secretory occurred between phase 2 and 3. At the transcriptomic level, proliferative endometrium can be divided into 2 distinct phases with unique transcriptomic signatures.This study involved the systematic characterization of the human endometrium across the menstrual cycle through dynamic gene expression mapping. The results demonstrate that ciliated epithelium are a transcriptomically distinct endometrial cell type that are highly prevalent in the human endometrium and constantly changing in abundance across the cycle. This study likewise demonstrated an abrupt and strong transcriptomic activation in unciliated epithelia and a gradual activation in stromal fibroblasts to define the opening of the WOI, indicating a potential diagnostic target for more precise in vitro fertilization and embryo transfer.

(Abstracted from Am J Obstet Gynecol 2016;215(6):684–703) In 2002, the vaginal microbiota was first identified using molecular methods that allowed detection of nonculturable bacteria. Alterations in vaginal microbiota could have clinical implications for reproductive and obstetric processes.

Our results reveal that elevated progesterone levels on the day of rCG administration can induce significant alterations in the gene expression profile of the endometrium.

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A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).