Endometrial recptivity

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Endometrial receptivity

Transcript of Endometrial recptivity

  • Benha University Hospital, Egypt Aboubakr Elnashar
  • 1. Why? 2. What? 3. When? 4. How? 5. Effect of COH on endometrial receptivity 6. Effect of age on endometrial receptivity 7. Assessment of endometrial receptivity: Functional markers: 1. Biochemical 2. Histological Clinical assessment: 1.TVS 2. 3DUS 3.Doppler US 8. Improvement of endometrial receptivity Aboubakr Elnashar
  • The main causes of failure of IVF is failure embryo implantation. Embryo implantation depends on: 1.The quality of the embryo 2.Endometrial receptivity. 3. The embryo/endometrial interface Aboubakr Elnashar
  • The onset of implantation is a successful meeting of 2 separate processes: embryo development & endometrial differentiation. A synchrony between these functions is important. Aboubakr Elnashar
  • Aboubakr Elnashar
  • Understanding of 1.The mechanisms involved in this process 2. How to assess? & 3. How to treat its disorders represent the fundamental steps in the improvement of IVF. Aboubakr Elnashar
  • Temporally unique sequence of factors that make the endometrium receptive to embryonic implantation The window of time when the uterine environment is conductive to blastocyst acceptance & subsequent implantation Aboubakr Elnashar
  • The endometrium is normally hostile environment for an embryo , except during implantation window. Implantation window: It is a period during which the endometrium is optimally receptive to implanting blastocyst Aboubakr Elnashar
  • Duration: 4 to 5 days D6 to D10 postovulation, or D7 to D11 post LH surge or D20 to D24 of 28 D cycle Aboubakr Elnashar
  • Benefits of determining the implantation window: It may be possible to Widen the implanation window by manipulating the pre- & peri-implantation endocrine environment Correlate endocrine, biochemical & morphological changes with endometrial receptivity Recognize the time for ET that would best correspond with the implantation window Aboubakr Elnashar
  • Initiation of ER depend on: the down regulation of endometrial PR & estrogen receptors induced by P (Lindhard et al,2003). When the embryo has arrived in the endometrial cavity: a preprogrammed sequence of events occurs, which involves the secretion of a multitude of biochemical factors by the endometrium & the embryo, leading to to the formation of a receptive endometrium. Aboubakr Elnashar
  • Some factors like integrins like v 3 make the endometrium receptive & others like MUC1 make it resistant to implantation except in small areas Aboubakr Elnashar
  • Abnormalities of the luteal phase have been detected in all the stimulation protocols on both hormonal & endometrial levels. COH adversely affect endometrial receptivity(Devroey et al, 2004)Aboubakr Elnashar
  • Etiology: 1. High concentration of estrogens & progesterone, altered E2 to progesterone ratios. 2. Disturbed LH levels 3. Corpus luteum deficiency (Albano et al, 1998). 4. A direct effect of GnRh agonist or antagonist on the corpus luteum or on endometrium 5. Altered endometrial receptivity from endometrial asynchrony & earlier expression of pinopodes Aboubakr Elnashar
  • Endometrial histology has revealed a wide range of abnormalities during the various ovarian stimulation protocols (Ubaldi et al, 1997). In GnRh-agonist cycles, mid-luteal biopsies has revealed: increased glandulo-stromal dyssynchrony delay in endometrial development, strong positivity of endometrial glands for PR, decreased cell adhesion molecule profiles and earliest appearance of surface epithelium pinopodes (Soliman et al, 1994). Aboubakr Elnashar
  • These factors suggest a shift forwards of implantation window. Progesterone supplementation improves endometrial histology, and its necessity has been established, at least in cycles, using GnRh agonists (Soliman et al, 1994). Aboubakr Elnashar
  • There is increased peri-ovulatory P in the COH cycles. The early rise of P has a negative impact on endometrial receptivity but not on oocyte-embryo quality these cause premature endometrial lutenization & provide an explanation for the observed decrease in endometrial receptivity (De long et al, 2000). Aboubakr Elnashar
  • On the other hand (Levi et al,2001). Implantation & pregnancy rates did not differ between IVF-ET patients and recipients of donor oocytes. Exposure of the developing endometrium to COH during IVF cycles does not inhibit embryo implantation or affect pregnancy rate. Aboubakr Elnashar
  • Embryo implantation rates declines in a linear fashion from 29% in women