Optimal uterine anatomy and physiology necessary for normal implantation and placentation

Abstract

The authors review aberrations of uterine anatomy and physiology affecting pregnancy outcomes with IVF. In the case of endometriosis and hydrosalpinx, pathologies outside of the uterus alter the uterine endometrium. In the case of endometriosis, Dominique de Ziegler outlines the numerous changes in gene expression and the central role of inflammation in causing progesterone resistance. With endometriosis, the absence of ovarian function inherent in deferred transfer, with or without a more lengthy suppression of ovarian function, appears to be sufficient to restore normal function of eutopic endometrium. Because laparoscopy is no longer routine in the evaluation of infertility, unrecognized endometriosis then becomes irrelevant in the context of assisted reproductive technology. With hydrosalpinx and submucus myomas, the implantation factor HOXA-10 is suppressed in the endometrium and, with myomas, even in areas of the uterus not directly affected. Daniela Galliano reviews various uterine pathologies, the most enigmatic being adenomyosis, where the endometrium also manifests many of the changes seen in endometriosis and deferred transfer with extended suppression appears to provide the best outcomes. Ettore Cicinelli's group has extensively studied the diagnosis and treatment of endometritis, and although more definitive diagnosis and care of this covert disorder may await techniques such as sequencing of the endometrial microbiome, it undoubtedly is an important factor in implantation failure, deserving our attention and treatment.

Repeated implantation failure at the crossroad between statistics, clinics and over-diagnosis

“…These arguments have been exhaustively reviewed recently (Simon and Laufer, 2012;Coughlan et al, 2014a;de Ziegler et al, 2016;Zohni et al, 2016). A tentative list of possible factors interfering with embryo implantation and possible treatments is shown in Table 1 (Johnson et al, 2010;Practice Committee of ASRM, 2012;Brady et al, 2013;Li et al, 2013;Vercellini et al, 2014;Bosteels et al, 2015;Crawford and Steiner, 2015; Practice Committee of ASRM, 2015; Ata and Urman, 2016;de Ziegler et al, 2016;Ko et al, 2016; Practice Committee of ASRM, 2016; Robertson et al, 2016;Zuini et al, 2017). Of relevance here is that factors that are well-known to interfere with embryo implantation, and that are amenable to effective, economic and safe therapies, deserve to be identified and treated before embarking on an IVF programme.…”

“…For more in-depth systematic reviews, see Simon and Laufer (2012), Coughlan et al (2014a), Zohni et al (2016) andde Ziegler et al (2016). b If available, reviews were preferred.…”

Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception

“…UI is diagnosed in about 15% of couples seeking medical advice, when standard investigations fail to identify any abnormality . Due to poor spontaneous pregnancy rate (between 2% and 4% per menstrual cycle) and the lack of clear targets for therapy, such patients are often submitted to ARTs, with limited results …”

Effect of hyaluronic acid–enriched transfer medium on frozen–thawed embryo transfer outcomes

“…Embryo implantation is a complex interaction between the embryo and the endometrium . Cross‐talk between the embryo and the endometrium is mandatory for successful implantation, and subsequent normal placentation .…”

“…Embryo implantation is a complex interaction between the embryo and the endometrium . Cross‐talk between the embryo and the endometrium is mandatory for successful implantation, and subsequent normal placentation . While there are many factors that can affect the interaction of the embryo and the endometrium, the embryo transfer (ET) medium used in ART may have an effect on both the embryo and the endometrium .…”