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基于子宫内膜容受性评估的个体化胚胎移植 (pET) - 提高体外受精 (IVF) 成功率的一种可能。现有方法的综述。

Personalized embryo transfer (pET) guided by endometrial receptivity (ER) assessment - a possibility to increase effectiveness of IVF procedures. Review of available methods.

机构信息

III Faculty and Clinic of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland.

OVIklinika Infertility Center, Warsaw, Poland.

出版信息

Ginekol Pol. 2023;94(12):1004-1010. doi: 10.5603/GP.a2023.0041. Epub 2023 May 10.

Abstract

The continuous development of assisted reproductive techniques (ART) implies the search for solutions that could increase the effectiveness ofavailable methods. In the context of in vitro fertilization (IVF), a significant proportion of failures are due to unsuccessful embryo transfers. At this stage the most important issue is proper dialogue between implanting embryo and the maternal endometrium. Therefore, it seems justified to assess endometrial receptivity (ER), defined as the tissue's ability to accept an embryo to attach and invade into the mucosa. Window of implantation (WOI), is a certain period in which implantation of the properly developed embryo is possible. The cause of endometrial receptivity disorders is believed to be the disturbed expression of cytokines and endometrial surface proteins, the presence of which has been proven in commonly diagnosed diseases such as endometriosis or chronic endometritis. Despite many years of research on endometrial receptivity, the area of ​​diagnostic methods enabling clinical monitoring of ER still remains undeveloped. The aim of this study is to review the utility of selected markers and the available methods of ER assessment, ranging from noninvasive ultrasound, through endometrial fluid analysis, to genomic studies based on endometrial biopsy, in order to increase the effectiveness of IVF. Such an approach could potentially be a significant step towards personalizing medical procedures especially in patients diagnosed with repeated implantation failure (RIF).

摘要

辅助生殖技术(ART)的不断发展意味着需要寻找能够提高现有方法效果的解决方案。在体外受精(IVF)的背景下,相当一部分失败是由于胚胎移植不成功。在这个阶段,最重要的问题是植入胚胎和母体子宫内膜之间的适当对话。因此,评估子宫内膜容受性(ER)似乎是合理的,子宫内膜容受性定义为组织接受胚胎附着和侵入黏膜的能力。着床窗口期(WOI)是适当发育的胚胎可以着床的特定时期。子宫内膜容受性障碍的原因被认为是细胞因子和子宫内膜表面蛋白的表达紊乱,这些蛋白的存在已在子宫内膜异位症或慢性子宫内膜炎等常见诊断疾病中得到证实。尽管对子宫内膜容受性进行了多年的研究,但仍缺乏能够对 ER 进行临床监测的诊断方法。本研究的目的是回顾评估子宫内膜容受性的选定标志物和现有方法的效用,范围从非侵入性超声,到子宫内膜液分析,再到基于子宫内膜活检的基因组研究,以提高 IVF 的效果。这种方法可能是朝着个性化医疗程序迈出的重要一步,特别是在反复着床失败(RIF)的患者中。

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