The role of uterine contractility in embryo implantation: novel approaches in diagnosis

Presentation at the 5th SSRHR Meeting, Heraklion, Crete, 8-10 October 2021.

It was an honour to take part to a very successful meeting of the SSHRH, presenting current data on diagnosis of uterine contractility, as well as communicating a collaborative research project in uterine contractility and embryo implantation.

Embryo implantation is a complex procedure, involving a host of different factors, including both embryo-related factors, as well as the uterine environment. Uterine contractility has been recognised as an important aspect of uterine physiology in aid of embryo implantation since the mid-1990s, when researchers described the cyclicity of uterine contractility, in relation to different phases of the menstrual cycle, as well as, in relation to IVF treatment outcomes. A good body of research work suggested that increased uterine contractility, as assessed by transvaginal ultrasound, was associated with decreased implantation rates, as well as clinical pregnancy rates.

However, the subjective nature of conventional transvaginal ultrasound assessment, along with technical difficulties in imaging contractility of the inner myometrium, posed a limitation in wide acceptance of such methods in diagnosing uterine contractility.

More recently, following the innovative research work by Federica Sammali in 2018, speckle tracking technology has been introduced in the ultrasound assessment of uterine contractility. An objective and more accurate way to record uterine activity, speckle tracking allows the characterisation of uterine contractility in various phases of the menstrual cycle and evaluates the impact of exogenous factors, such as the hormonal treatment during ovarian stimulation in IVF, as well as the impact of uterine pathology, as in leiomyomas and adenomyosis, on embryo implantation following embryo transfer.

Our clinical team, in Embryolab Fertility Clinic, has recently started a collaboration with the University of Technology in Eindhoven and Catharina Hospital, in a research project aiming to evaluate uterine contractility in women of special research interest, as in women who are having elective freeze-all of their embryos in IVF, as well as in recipients of donor oocytes. The aim of our study is to evaluate the impact of hormonal treatments in uterine activity, as well delineate the true impact of uterine pathology in treatment outcomes in oocyte donation treatments.

©2021, Nicholas Christoforidis, Fertility Matters
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