ART and uterine pathology: how relevant is the maternal side for implantation?
- PMID: 25155826
- DOI: 10.1093/humupd/dmu047
ART and uterine pathology: how relevant is the maternal side for implantation?
Abstract
Background: Assisted reproduction technology (ART) has become a standard treatment for infertile couples. Increased success rates obtained over the years have resulted primarily from improved embryo quality, but implantation rates still remain lower than expected. The uterus, an important player in implantation, has been frequently neglected. While a number of uterine pathologies have been associated with decreased natural fertility, less information exists regarding the impact of these pathologies in ART. This report reviews the evidence to help clinicians advise ART patients.
Methods: An electronic search of PubMed and EMBASE was performed to identify articles in the English, French or Spanish language published until May 2014 which addressed uterine pathology and ART. Data from natural conception were used only in the absence of data from ART. Studies were classified in decreasing categories: RCTs, prospective controlled trials, prospective non-controlled trials, retrospective studies and experimental studies. Studies included in lower categories were only used if insufficient evidence was available. Pooled data were obtained from systematic reviews with meta-analyses when available. The summary of the evidence for the different outcomes and the degree of the recommendation for interventions were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) statement recommendations.
Results: There is strong evidence that surrogacy is effective for uterine agenesia. For the remaining pathologies, however, there is very little evidence that the established treatments improve outcomes, or that these pathologies have a negative effect on ART. In the presence of an apparently normal uterus, assessing endometrial receptivity (ER) is the goal; however diagnostic tests are still under development.
Conclusions: The real effect of different uterine/endometrial integrity pathologies on ART is not known. Moreover, currently proposed treatments are not based on solid evidence, and little can be done to assess ER in normal or abnormal conditions. No strong recommendations can be given based on the published experience, bringing an urgent need for well-designed studies. In this context, we propose algorithms to study the uterus in ART.
Keywords: assisted reproduction; endometrial receptivity; endometrium; implantation; uterus.
© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Similar articles
-
Epigenetic clocks provide clues to the mystery of uterine ageing.Hum Reprod Update. 2023 May 2;29(3):259-271. doi: 10.1093/humupd/dmac042. Hum Reprod Update. 2023. PMID: 36515535 Review.
-
Identifying biomarkers for predicting successful embryo implantation: applying single to multi-OMICs to improve reproductive outcomes.Hum Reprod Update. 2020 Feb 28;26(2):264-301. doi: 10.1093/humupd/dmz042. Hum Reprod Update. 2020. PMID: 32096829 Review.
-
How uterine microbiota might be responsible for a receptive, fertile endometrium.Hum Reprod Update. 2018 Jul 1;24(4):393-415. doi: 10.1093/humupd/dmy012. Hum Reprod Update. 2018. PMID: 29668899 Review.
-
The management of uterine fibroids in women with otherwise unexplained infertility.J Obstet Gynaecol Can. 2015 Mar;37(3):277-285. doi: 10.1016/S1701-2163(15)30318-2. J Obstet Gynaecol Can. 2015. PMID: 26001875
-
The management of uterine leiomyomas.J Obstet Gynaecol Can. 2015 Feb;37(2):157-178. doi: 10.1016/S1701-2163(15)30338-8. J Obstet Gynaecol Can. 2015. PMID: 25767949
Cited by
-
Personalized embryo transfer guided by rsERT improves pregnancy outcomes in patients with repeated implantation failure.Front Med (Lausanne). 2024 May 15;11:1369317. doi: 10.3389/fmed.2024.1369317. eCollection 2024. Front Med (Lausanne). 2024. PMID: 38813375 Free PMC article.
-
Establishment of Murine Pregnancy Requires the Promyelocytic Leukemia Zinc Finger Transcription Factor.Int J Mol Sci. 2024 Mar 19;25(6):3451. doi: 10.3390/ijms25063451. Int J Mol Sci. 2024. PMID: 38542422 Free PMC article.
-
Endometrial transcriptome profiling of patients with recurrent implantation failure during hormone replacement therapy cycles.Front Endocrinol (Lausanne). 2024 Jan 30;14:1292723. doi: 10.3389/fendo.2023.1292723. eCollection 2023. Front Endocrinol (Lausanne). 2024. PMID: 38352249 Free PMC article.
-
Endometrial proteomic profile of patients with repeated implantation failure.Front Endocrinol (Lausanne). 2023 Jul 31;14:1144393. doi: 10.3389/fendo.2023.1144393. eCollection 2023. Front Endocrinol (Lausanne). 2023. PMID: 37583433 Free PMC article.
-
Can biomarkers identified from the uterine fluid transcriptome be used to establish a noninvasive endometrial receptivity prediction tool? A proof-of-concept study.Reprod Biol Endocrinol. 2023 Feb 18;21(1):20. doi: 10.1186/s12958-023-01070-0. Reprod Biol Endocrinol. 2023. PMID: 36805767 Free PMC article.
Publication types
MeSH terms
Supplementary concepts
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical