2. - dynamic tissue
- changes during the menstrual cycle
- Decidualization is the most imazing
- E.R : balance between adhesion, invasion, growth differentiation, immuno-
modulation.
Endometrium
4. Conception needs a receptive endometrium and a competent blastocyst. (Kim
SM et al.,2017)
It usually occurs between day 20-24 of the menstrual cycle or day 6-10 post
ovulation. (Bruce Lessey ., 2011)
Window of Implantation (WOI) : Max receptivity
7. - Endometrial biopsy at time of OPU
- Ultrasound markers
- Biochemical markers
- OMICS
Markers of Endometrial Receptivity
8. • Noyes et al 1950 established morphological criteria to evaluate endometrial
development and receptivity. The use of Noyes criteria to predict the WOI
accurately has been questioned and randomized studies have invalidated
their use.(Coutifaris C .,2004)
• It needs biopsy !!
Histological Markers
9. Endometrial pinopods 2010
Normal endometrial secretory
epithelial cells. Most secretory cells
bears a fully developed pinopodes
which may protrude beyond the length
of ciliated cells
(Marina Aunapuu et al .,2018)
Again require biopsy
10. IVF & Endometrial receptivity
High
Estradiol
Up-regulates
PR-rec
Progesterone
rise
Advanced
endometriu
m
Implantation
failure
11. OPU If advancement > 3days No pregnancy!!!
(Ubaldi,1997; Kolibianakis, 2002)
HCG
B B
High estradiol
up-regulates
PR
Day-3
Day-5
14
12. Other Factors
CD
56
Il-1
• Stimulates Il-6, Il-8, LIF, TNFa,
PGE2, COX-2, MMP, Integrins
• Knockouts not infertile
Gp 130 cytokines
• Il-6, increases MMP-9
• Il-11, decidualization of stroma
• LIF, decidualization,
cytotrophoblast anchoring
Il-15
• Cell-cell interaction decidua-Nkcell
CRH
• Decidualization
• Inhibit immune response with Fas-
ligand
MUC-1
Natural Killer
Leucocytes
13. • endometrial thickness and pattern
• Endometrial volume
• sub-endometrial vascularization index
• Not reliable as a diagnostic marker for endometrial receptivity
Ultrasound markers
15. Biochemical markers
E-tegrity test
E-tegrity Plus test
Endometrial
function test (EFT)
based on Beta-3 integrin expression
Which is a glue-like protein, necessary for implantation to take
place
combines Beta-3 integrin, with a newly discovered biomarker,
BCL6 which is a gene repressor and accurate predictor for the
presence of inflammation caused by endometriosis,
adenomyosis, or tubal disease
is based on alterations in cyclin E and on p27 expression
(Kliman HJ et al.,2006) (Germeyer A et al., 2014) (Chelsea Fox et al .,2016)
16. - lack accuracy and a predictive value.
- All fades away
Unfortunately
17. biological samples
- genomics (study of genes),
- transcriptomics (study of gene expression),
- proteomics (quantification of proteins),
- metabolomics
Currently, transcriptomics are considered the most established technology
available for evaluation of E.R (Messaoudi S et al.,2019)
OMICS
19. How it works
Amplification & labelling
Hybridization on chip
Endometrium cells
RNA extraction
Affymetrix GeneChip®
Operating Software
(GCOS)
20. - Require frozen embryo transfer (FET)
Commercially available
the ERA test (Endometrial
Receptivity Array) :
a customized array based on the
expression of 238 genes coupled
to a computational predictor
capable of diagnosing a
functionally receptive
endometrium.(Diaz-Gimeno P et
al.,2011)
21. - Recurrent implantation failure
- Single embryo transfer (sET). (Barzilay Eran et al.,2018)
- endometrial biopsy must be performed at P+5 (hormone replacement
therapy cycle) or at LH+7 (natural cycle)
Invasive
22. But
• No RCT have been conducted
• Commercially propagated without clear evidence
24. • Recent research has identified the existence of an endometrial microbiome,
• pathogenic variations of endometrial Lactobacilli levels could play a role in
RIF. (Moreno et al., 2016).
• EMMA can determine if the uterine microbial environment is optimal for
embryo implantation.
• Percentage of Lactobacilli in the endometrial sample
Endometrial microbiome metagenomic Analysis
(EMMA)
25. the aim of improving the clinical management of patients with this silent
disease. (Moreno et al.,2018)
Analysis of chronic infectious endometritis
(ALICE)
31. Gn effect on endometrium ( September 2020)
• Reducing dose of Gn in COH
• Max dose is 300 Iu
• Preferable starting dose is 150 IU for those with AMH 1-4
32.
33. Immune system
• NK cells assay
• Intralipid infusion
• No evidence of effectiveness