Endometrium And Embryo Implantation

Practical, evidence-based review of all factors that can affect the endometrium and influence implantation success rates.

Implantation of the embryo into the maternal endometrium represents a crucial step in the reproductive process. It results from a cascade of finely tuned events. Despite recent progress in the field, many points still require clarification. This special issue offers a broad coverage of the latest findings. New concepts and applications are presented which are based on data strongly suggesting that both embryo implantation and uterine receptivity are controlled, primarily, though not exclusively, by locally acting growth factors and cytokines. Different processes are also studied, such as the MMPs expression regulating the trophoblast invasion, or the possible secretion of sHLA-G molecules by human embryos and its correlation to a successful pregnancy. Further points under discussion are the chromosomal imbalance leading to embryonic mortality, and the potential of the baboon model to study embryo implantation. Finally, a comparative survey is given of the general mechanical, endocrinological and cellular aspects involved in implantation in mammals. Clinicians as well as basic researchers will find this special issue to be a valuable source of new insights.

The advent of assisted conception procedures such as in-vitro fertili sation (IVF) has provided the impetus for exploration of the factors that lead to the establishment of pregnancy. This collection of papers from leading research workers brings together current concepts of the processes which may be of importance in implantation. The complex signals from the embryo to the ovary, endometrium and myometrium are now being revealed through studies in both primates and other mammalian species. This book addresses the interrelationship of pituitary and ovarian hormones in controlling ovulation and the preparation of the intrauterine environment for implantation. Once fertilisation has occurred and trophoblast has formed, the next vital step is the production of materials which signal the presence of the pregnancy to the rest of the body. Trophoblastic proteins and other early-pregnancy factors are prime candidates for this role. Recent studies have emphasised the importance of the intrauterine environment in implantation. Specific secretory products of the endometrium have great potential in this process. The prostaglandins also play an essential part. Immunological adjustments are now considered a condition for the successful establishment of pregnancy. The possible use of immuno therapy in the treatment of recurrent abortion has highlighted interest in this area. The use of immunological techniques for contraception are in their infancy but offer much hope for the future.

This unique text discusses the wide range of causes and pathophysiologic conditions contributing to recurrent implantation failure (RIF) and the current treatment approaches to best approach this challenging patient population. Beginning with a presentation of the mechanism of normal implantation, the physiologic synchrony between embryo and endometrium, and the roles of both gametes and embryos in RIF, the book then examines the various genetic, immune and environmental factors involved. Abnormalities of the hematologic and endocrine system, as well as those of the anatomy and microbiome, are described in detail. Last but no less important, the psychological stress and treatment of patients experiencing RIF is discussed. Assisted reproductive technology (ART) success has increased substantially over the past three decades. However, despite these advances, recurrent implantation failure is still a common issue confronting patients and clinicians, and RIF represents one of the greatest challenges in ART and remains a source of frustration and disappointment for patients, clinicians, and researchers involved in the process. Providing an in-depth investigation into the pathophysiology and biological mechanisms of RIF and its clinical management, this will be an excellent resource for reproductive endocrinologists and infertility specialists.

Interest in mechanisms of embryo implantation is increasing, particularly with the realization that failure of implantation after in vitro fertilization and embryo transfer places significant limits on the success of treatment. In addition, there is a need to provide hypotheses, and ultimately mechanisms, for the high rates of embryonic loss in women in the population at large. Traditionally, implantation research has concentrated on genetics and endocrinology without providing many therapeutic benefits. A new era is now beginning with the application of modem cellular and molecular approaches to the investigation of the relationship between trophoblast and endometrium. At the same time, older data can be reevaluated in the light of current research into cell cell and cell-matrix interactions. The feeling that new avenues of research are open was apparent when an international group of scientists came together at a workshop on "The Cell Biology of Trophoblast Invasion In Vivo and In Vitro" held during the XXIV Annual Meeting of the Cell, Tissue and Organ Culture Study Group (C.T.O.C.) at Heidelberg in 1986. What was unusual about this Conference was the interdisciplinary dialogue between implantation researchers and tumor biologists, highlighting aspects common to invasion of trophoblast and tumor cells.

The structural, biochemical and clinical events related to menstruation, implantation, parturition, endometriosis, abnormal uterine bleeding and endometrial cancer are discussed in this comprehensive volume on the biological functions of the endometrium. New topics, such as the biochemical and molecular mechanisms regulating maternal embryonic interaction, are explored, and gynecologic endoscopy and therapeutic tools are discussed. The proceedings of the first conference is also available from the Academy, as volume 622 of The Annals of The New York Academy of Science.

Practical and effective; this book supports challenging clinical and laboratory issues that the IVF practitioner faces all day, every day.