Поиск идеального маркера для оценки рецептивности эндометрия: от гистологии до современных молекулярно-генетических подходов

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Аннотация

 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.

Об авторах

М. В. Кибанов

Клинический госпиталь на Яузе

Автор, ответственный за переписку.
Email: mkibanov@gmail.com

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

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

Россия

Г. М. Махмудова

Клинический госпиталь на Яузе

Email: fake@neicon.ru

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

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

Россия

Я. А. Гохберг

Клинический госпиталь на Яузе

Email: fake@neicon.ru

Гохберг Яэль Александровна – ординатор

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

Россия

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