Successful treatment with intrauterine delivery of dexamethasone for repeated implantation failure

Abstract

We report for the first time the beneficial effect of intrauterine perfusion of DXM for patients with RIF characterized by high number of uNK cells. The potential mechanism is downregulation of the proportion of uNK cells, which may improve endometrial receptivity and enhance embryo implantation.

Intrauterine infusion of human chorionic gonadotropin before embryo transfer in IVF/ET cycle: The critical review

“…Overactivated complement C3 compromised fetal survival and led to fetal loss. 64 Either extremely lower or higher percentage and/or function of uNK are adverse for endometrial receptivity and embryo implantation, 65,66 leading to the use of NK cell phenotype as a potential marker of endometrial receptivity for women subject to reproductive failure. Moreover, decay-accelerating factor (DAF), one of complement regulatory proteins to protect host cells from the attack by the activated complement system, was increased in the luminal compartment, potentially to maintain a safe environment for embryonic implantation.…”

“…Moreover, decay-accelerating factor (DAF), one of complement regulatory proteins to protect host cells from the attack by the activated complement system, was increased in the luminal compartment, potentially to maintain a safe environment for embryonic implantation. 65,68 However, there is still no clinical trial about medical intervention for women with lower uNK counts. Recently, high dose (10 000 IU) of urine-purified hCG was shown to modulate uterine natural killer (uNK) cell proliferation via mannose receptors (CD206), rather than by the classical LH/hCG receptors which are not expressed on uNK cells.…”

“…13,44,65,66,124 Using these "diagnostic" methods, potential candidates for IUI-hCG can be selected and therapeutic effect can be More importantly, all the reported studies that conducted this intervention were based on the population characteristics (ie implantation failure, infertile), but not on etiological indications (ie the number of NK cells, or expression of cytokines).…”

“…With uNK being the major leukocytes present in the endometrium, they can increase dramatically up to 70% of endometrial leukocytes population during peri-implantation period. 64 Either extremely lower or higher percentage and/or function of uNK are adverse for endometrial receptivity and embryo implantation, 65,66 leading to the use of NK cell phenotype as a potential marker of endometrial receptivity for women subject to reproductive failure. 67 Also, glucocorticoid was reported to efficiently reduce the cell number and function of uNK cells and improve endometrial receptivity.…”

“…67 Also, glucocorticoid was reported to efficiently reduce the cell number and function of uNK cells and improve endometrial receptivity. 65,68 However, there is still no clinical trial about medical intervention for women with lower uNK counts. Hence, this makes hCG a potential therapy to deserve more attention in the future.…”