The University of Southampton
University of Southampton Institutional Repository

Preconception lifestyle modification of decidua to decrease early pregnancy loss: feeding the endometrium

Preconception lifestyle modification of decidua to decrease early pregnancy loss: feeding the endometrium
Preconception lifestyle modification of decidua to decrease early pregnancy loss: feeding the endometrium

 With IVF results now showing good evidence of having reached a steady plateau [1] despite the introduction of impressive new laboratory techniques aimed at selecting the embryo most likely to implant, attention is increasingly turning to the other key determining factor of successful implantation: the endometrium. The uterine factor in implantation has long been considered to be minor, but as the impact of further advances in embryology appears likely to remain incremental at best, clinicians, scientists, and biotech companies are focusing on the maternal side of the implantation equation. The concept of clinical manipulation of endometrial receptivity in infertility is not new. Many patients are offered a “smorgasbord” of adjuvant therapies aimed at improving the chance of the transferred embryo successfully implanting, but the clinical impact of these largely empirical therapies has thus far been disappointing. Perhaps it is time therefore to consider the endometrium in a different way. The paradigm of the endometrium as an essentially passive partner in implantation has gained currency with the growth of embryology and the impressive gains made in culture, freezing, and selection techniques. This reductionist view of the endometrium has gained support from results of oocyte donation programs, in which good outcomes are reported in women who failed to conceive with their own eggs. The assumption that this indicates that only embryo quality is the determining factor ignores the more hormonally physiological environment into which embryos derived from donor eggs are placed. Indeed, the excellent results now being achieved with frozen embryo thaw cycles, where embryos are transferred into an unstimulated endometrium, are being widely attributed to this factor. However, the intra-uterine environment is now being recognized as a key factor, not only in determining successful implantation, but in the nutrition and programming of the peri-implantation embryo. These new insights are providing novel opportunities for therapeutic and indeed nutritional interventions aimed at optimizing the peri-conceptional milieu. It is time to re-evaluate the endometrium as a more active partner in implantation. In this chapter, recent advances in our understanding of the dynamic biosensor and supportive role played by the endometrium will be outlined, and preconceptional interventions aimed at improving endometrial function will be reviewed. Finally, novel strategies for modifying preconceptional behaviors will be introduced.

131-142
Cambridge University Press
Kermack, Alexandra
b01db302-47bf-4319-a270-4cbbf26045c8
Ng, Ka Ying Bonnie
de4b89c4-ddf2-4820-a91f-8a2c3eefe407
Macklon, Nick
d08e4844-96cf-4333-aa84-aec9b8febb42
Kovacs, Gab
Norman, Robert
Kermack, Alexandra
b01db302-47bf-4319-a270-4cbbf26045c8
Ng, Ka Ying Bonnie
de4b89c4-ddf2-4820-a91f-8a2c3eefe407
Macklon, Nick
d08e4844-96cf-4333-aa84-aec9b8febb42
Kovacs, Gab
Norman, Robert

Kermack, Alexandra, Ng, Ka Ying Bonnie and Macklon, Nick (2018) Preconception lifestyle modification of decidua to decrease early pregnancy loss: feeding the endometrium. In, Kovacs, Gab and Norman, Robert (eds.) How to Improve Preconception Health to Maximize IVF Success. Cambridge. Cambridge University Press, pp. 131-142. (doi:10.1017/9781316727119.014).

Record type: Book Section

Abstract

 With IVF results now showing good evidence of having reached a steady plateau [1] despite the introduction of impressive new laboratory techniques aimed at selecting the embryo most likely to implant, attention is increasingly turning to the other key determining factor of successful implantation: the endometrium. The uterine factor in implantation has long been considered to be minor, but as the impact of further advances in embryology appears likely to remain incremental at best, clinicians, scientists, and biotech companies are focusing on the maternal side of the implantation equation. The concept of clinical manipulation of endometrial receptivity in infertility is not new. Many patients are offered a “smorgasbord” of adjuvant therapies aimed at improving the chance of the transferred embryo successfully implanting, but the clinical impact of these largely empirical therapies has thus far been disappointing. Perhaps it is time therefore to consider the endometrium in a different way. The paradigm of the endometrium as an essentially passive partner in implantation has gained currency with the growth of embryology and the impressive gains made in culture, freezing, and selection techniques. This reductionist view of the endometrium has gained support from results of oocyte donation programs, in which good outcomes are reported in women who failed to conceive with their own eggs. The assumption that this indicates that only embryo quality is the determining factor ignores the more hormonally physiological environment into which embryos derived from donor eggs are placed. Indeed, the excellent results now being achieved with frozen embryo thaw cycles, where embryos are transferred into an unstimulated endometrium, are being widely attributed to this factor. However, the intra-uterine environment is now being recognized as a key factor, not only in determining successful implantation, but in the nutrition and programming of the peri-implantation embryo. These new insights are providing novel opportunities for therapeutic and indeed nutritional interventions aimed at optimizing the peri-conceptional milieu. It is time to re-evaluate the endometrium as a more active partner in implantation. In this chapter, recent advances in our understanding of the dynamic biosensor and supportive role played by the endometrium will be outlined, and preconceptional interventions aimed at improving endometrial function will be reviewed. Finally, novel strategies for modifying preconceptional behaviors will be introduced.

This record has no associated files available for download.

More information

Published date: 1 February 2018

Identifiers

Local EPrints ID: 422485
URI: http://eprints.soton.ac.uk/id/eprint/422485
PURE UUID: 4502a467-029a-4fe2-8305-33b571173bb7
ORCID for Alexandra Kermack: ORCID iD orcid.org/0000-0002-9176-9426

Catalogue record

Date deposited: 24 Jul 2018 16:30
Last modified: 05 Jun 2024 19:50

Export record

Altmetrics

Contributors

Author: Alexandra Kermack ORCID iD
Author: Ka Ying Bonnie Ng
Author: Nick Macklon
Editor: Gab Kovacs
Editor: Robert Norman

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×