Implantation failure: molecular mechanisms and clinical treatment

Hakan Cakmak, Hakan Çakmak, Hugh S Taylor
Human reproduction update · 2010 · vol. 17(2) , pp. 242–253 · doi:10.1093/humupd/dmq037 · PMID:20729534 · PMC3039220 · W2154471974
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This review discusses molecular mechanisms of implantation failure in gynecological diseases, emphasizing the role of endometrial receptivity and suggesting current treatments include addressing the underlying disease.

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Abstract

BACKGROUND: Implantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood. METHODS: This review summarizes the current knowledge about the proposed mechanisms of implantation failure in gynecological diseases, the evaluation of endometrial receptivity and the treatment methods to improve implantation. RESULTS: The absence or suppression of molecules essential for endometrial receptivity results in decreased implantation rates in animal models and gynecological diseases, including endometriosis, hydrosalpinx, leiomyoma and polycystic ovarian syndrome. The mechanisms are diverse and include abnormal cytokine and hormonal signaling as well as epigenetic alterations. CONCLUSIONS: Optimizing endometrial receptivity in fertility treatment will improve success rates. Evaluation of implantation markers may help to predict pregnancy outcome and detect occult implantation deficiency. Treating the underlying gynecological disease with medical or surgical interventions is the optimal current therapy. Manipulating the expression of key endometrial genes with gene or stem cell-based therapies may some day be used to further improve implantation rates.

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Condition tags

endometriosis

MeSH descriptors

Embryo Implantation Genital Diseases, Female Infertility, Female Adult Embryo Implantation Embryo Implantation Endometrium Endometrium Female Gene Expression Regulation Genes, Homeobox Genes, Homeobox Genital Diseases, Female Genital Diseases, Female Genital Diseases, Female Humans Infertility, Female Infertility, Female Infertility, Female Pregnancy

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