Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)97910.18786/2072-0505-2019-47-005REVIEW ARTICLEОБЗОРIn search for an ideal marker of endometrial receptivity: from histology to comprehensive molecular genetics-based approachesПоиск идеального маркера для оценки рецептивности эндометрия: от гистологии до современных молекулярно-генетических подходовKibanovM. V.КибановМ. В.
Russian Federation

Mikhail V. Kibanov – PhD (in Biol.), Biologist, Laboratory of Reproductive Genetics

15/1 Volochaevskaya ul., Moscow, 111033

Кибанов Михаил Викторович – кандидат биологических наук, биолог, лаборатория репродуктивной генетики

111033, г. Москва, Волочаевская ул., 15/1

mkibanov@gmail.comMakhmudovaG. M.МахмудоваГ. М.
Russian Federation

Gulnora M. Makhmudova – MD, PhD, Professor, Head Physician, Head of the Reproductive and Gynecology Department  

15/1 Volochaevskaya ul., Moscow, 111033

Махмудова Гульнора Маратовна – доктор медицинских наук, профессор, главный врач, заведующая Центром материнства и репродуктивных технологий

111033, г. Москва, Волочаевская ул., 15/1

GokhbergYa. A.ГохбергЯ. А.
Russian Federation

Yael A. Gokhberg – Postgraduate Student   

15/1 Volochaevskaya ul., Moscow, 111033

Гохберг Яэль Александровна – ординатор

111033, г. Москва, Волочаевская ул., 15/1

Yauza Medical CenterКлинический госпиталь на Яузе2602201947112252202201922022019Copyright ©; 2019, Kibanov M.V., Makhmudova G.M., Gokhberg Y.A.Copyright ©; 2019, Кибанов М.В., Махмудова Г.М., Гохберг Я.А.2019Kibanov M.V., Makhmudova G.M., Gokhberg Y.A.Кибанов М.В., Махмудова Г.М., Гохберг Я.А.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/979

Background: Despite significant improvements in the efficiency of assisted reproductive technologies (ART) for the past 10 years, proportion of unsuccessful cycles still remains significant and can reach up to 40%. Impairment of embryonic implantation is considered as one of the possible causes for low ART efficiency. Implantation failure may be a consequence of a shift in the “window of implantation”, i.e. the period of a cycle when endometrium is most receptive and ready for embryo implantation. Several methods have been developed to evaluate endometrial receptivity, but their accuracy and efficiency are quite different.

Aim: Review and efficiency evaluation of the methods used for endometrial receptivity assessment and the window of implantation determination.

Methods: We performed a comprehensive literature search (September 2018) with the key words “endometrial receptivity”, “endometrial receptivity evaluation”, “implantation window”, “window of implantation”, “pinopodes” from PubMed and E-library (Russian) databases. One hundred and thirty four (134) publications were selected for the analysis, including 101 original papers and 33 literature reviews.

Results: The methods of conventional histology, scanning electronic microscopy, immunohistochemistry, as well as techniques based on the measurement of prostaglandin levels in endometrial fluid and mRNA profiling in an endometrium biopsy sample to assess endometrial receptivity are reviewed. The issue of a search for an ideal endometrial receptivity marker is discussed.

Conclusion: At present, the most efficient and accurate methods to diagnose the window of implantation are those based on the mRNA profile assessment of an endometrial tissue sample. Аnalysis of mRNAs allows not only the accurate diagnosis of endometrial receptivity at the time of biopsy to be determined, but also the window of implantation shift to earlier or later periods to be reliably predicted.

 Актуальность. Несмотря на значительный рост эффективности программ вспомогательных репродуктивных технологий (ВРТ), наблюдаемый за последние 10 лет, доля безрезультатных циклов по-прежнему остается существенной и может достигать 40%. Нарушение имплантации эмбриона рассматривается как одна из возможных причин, ограничивающих результативность программ ВРТ. Отсутствие имплантации может быть связано со смещением периода «имплантационного окна» – времени, когда эндометрий обладает максимальной рецептивностью и готов к интеграции эмбриона. Для определения рецептивности эндометрия разработаны и используются различные методы. Однако точность и эффективность существующих подходов существенно разнятся.

Цель – обзор методов, используемых для исследования рецептивности эндометрия и определения периода «имплантационного окна», а также оценка их эффективности.

Методы. Проведен поиск источников (сентябрь 2018 г.) в базах данных PubMed и E-library по ключевым словам: “endometrial receptivity” / «рецептивность эндометрия», “endometrial receptivity evaluation” / «определение рецептивности эндометрия», “implantation window” / «имплантационное окно», “window of implantation” / «окно имплантации», “pinopodes” / «пиноподии». Для анализа отобраны 134 публикации, в том числе 101 оригинальная исследовательская работа и 33 обзора литературы.

Результаты. Рассмотрены методы классического гистологического анализа, сканирующей электронной микроскопии, иммуногистохимии, а также подходы, основанные на определении уровня простагландинов в эндометриальной жидкости и анализе профиля матричных РНК в образце ткани эндометрия, с целью определения рецептивности эндометрия. Обсужден вопрос поиска идеального маркера для оценки рецептивного статуса эндометрия.

Заключение. Сегодня наиболее эффективными и точными методами диагностики периода «имплантационного окна» представляются подходы, основанные на изучении транскрипционного профиля образца ткани эндометрия. Анализ представленности матричных РНК позволяет не только точно диагностировать уровень рецептивности эндометрия на момент биопсии, но и достоверно предсказать возможное смещение периода «имплантационного окна» на более ранний или более поздний сроки.

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