This document discusses various challenges related to uterine cavity that can impact IVF success rates. It discusses improving endometrial receptivity, strategies like ERA and EMMA tests. It also discusses challenges like unexplained recurrent implantation failure, intrauterine adhesions and treatments using stem cells, removing polyps and fibroids to improve fertility outcomes, and performing hysteroscopic metroplasty for septate uterus although no randomized trials exist. Overall, the document outlines several uterine factors that can influence IVF and discusses progress and remaining challenges in evaluating and addressing these factors.

1. Challenges in Uterine Cavity
Success vs Failure

2. IVF
Implantation
Endometium
quality
Oocyte
quality
Lab culture
quality

3. IVF & Endometrial receptivity
High Estradiol
Up-regulates
PR-rec
Progesterone
rise
Advanced
endometrium
Implantation
failure

4. Challenge I
• Understanding endometrial receptivity
• Identifying patients with decreased endometrial receptivity
• Strategies for improving endometrial receptivity

5. PROGRESS IN UNDERSTANDING ENDOMETRIAL RECEPTIVITY

6. For Unexplained recurrent implantation failure (Barzilay Eran et al.,2018)
Unfortunately, insufficient evidence of effectiveness
Extremely expensive
ERA

7. EMMA : Endometrial microbiome metagenomic Analysis
ALICE : Analysis of chronic infectious endometritis
ERA : Endometrial receptivity test
EndomeTRIO ???

8. Challenge II: IUA : Big challenge

9. 5-7 days 1 day 5 days 1 day 2-3 months 2-4 months
Menstruation
Methodology
HSC G-CSF
CD133+ Apheresis CD133+
Catheterism HSC ART
Mobilization of BMDSc from peripheral
blood Isolation of CD133+ Uterine Catheterism

10. 42-200x106 CD133+ infused
2,5 F microcatheter (0.014 in)

11. Clinical Results
Before Treatment 1 month after
treatment
2 months after
treatment
3 months after
treatment
Period Duration 1.94 ± 1.69 5.06 ± 0.85 3.81 ± 1.05 3.25 ± 1.06
Pads/day 1.19 ± 1.10 2.69 ± 1.19 2.12 ± 0.96 1.75 ± 1

12. Challenge III : Polyps : SIZE

13. Cochrane SR
• Hysteroscopic removal of polyps prior to IUI increases the
odds of clinical pregnancy compared to diagnostic
hysteroscopy. (OR 4.4 and 𝑃 < 0.00001).
Bosteels J. et al., Cochrane Database of Systematic Reviews, 2013.

14. ACOG Committee Opinion
Office hysteroscopy for the
treatment of endometrial
polyps should be
considered whenever
possible.
Obstet Gynecol 3th March,
2020

15. Challenge IV : SM myoma
Sub-mucous fibroids
interfere with fertility
and should be
removed in infertile
patients, regardless of
the size or the
presence of symptoms.
E. Taylor et al., Fertility and Sterility, 2008.

16. ASRM
‘‘There is fair evidence that hysteroscopic myomectomy for submucosal
fibroids improves clinical pregnancy rates’’. (Fertility and Sterility 2017)
No RCT has been conducted so far

17. Challenge V : Septum
No randomized controlled
trial evaluating the
effectiveness and possible
complications of
hysteroscopic metroplasty
has been published so far
Cochrane Database of Systematic Reviews, 2011.

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