Nathalie Lédée1, Laura Prat-Ellenberg2, Lucie Chevrier3, Richard Balet2, Cynthia Simon2, Clarisse Lenoble2, Elie El Irani2, Dominique Bouret2, Guy Cassuto2, Dominique Vitoux4, Katia Vezmar3, Armand Bensussan5, Gérard Chaouat6, Marie Petitbarat3. 1. Centre d'assistance médical à la procréation Bluets-Drouot, Hospital Les Bluets, 4 rue Lasson 75012 Paris, France; MatriceLAB Innove SARL, Saint-Louis Hospital, Pavillon Bazin, 1 Avenue Claude Vellefaux, 75010 Paris, France; Institut National de Santé et de Recherche Médicale, INSERM UMR-976, Saint-Louis Hospital, Research Center, 1 Avenue Claude Vellefaux, 75010, Paris, France; Paris Diderot University, Paris VII, 1 Avenue Claude Vellefaux, 75010 Paris, France. Electronic address: nathalie-ledee@orange.fr. 2. Centre d'assistance médical à la procréation Bluets-Drouot, Hospital Les Bluets, 4 rue Lasson 75012 Paris, France. 3. MatriceLAB Innove SARL, Saint-Louis Hospital, Pavillon Bazin, 1 Avenue Claude Vellefaux, 75010 Paris, France. 4. Plateforme AP-HP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France. 5. Institut National de Santé et de Recherche Médicale, INSERM UMR-976, Saint-Louis Hospital, Research Center, 1 Avenue Claude Vellefaux, 75010, Paris, France; Paris Diderot University, Paris VII, 1 Avenue Claude Vellefaux, 75010 Paris, France. 6. Institut National de Santé et de Recherche Médicale, INSERM UMR-976, Saint-Louis Hospital, Research Center, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Abstract
BACKGROUND: Embryo implantation remains the main limiting factor in IVF/ICSI program. Endometrial immune remodeling events begin before implantation and are a vital process for pregnancy, preparing future maternal immune tolerance and regulating the placentation process. METHODS: Between 2012 and 2014, 193 patients (analyzed group) enrolled in our IVF program benefitted of an endometrial immune profiling to determine if their uterus was immunologically ready to accept an embryo and, if not, the specific immune mechanisms involved. Subsequently, they had an effective embryo transfer (ET) with personalization of their treatments if an immune deregulation has been diagnosed. Each analyzed patient was paired to the closest patient included in the IVF program according to biological criteria (age, number of mature oocytes, stage and number of transferred embryo), which had no endometrial immune profiling (193 patients, non-analyzed group). FINDING: 78% of analyzed patients had a uterine immune dysregulation and therefore care personalization. Their corresponding live birth rate (LBR) was twice higher than observed in the matched control group with conventional cares (30.5% versus 16.6%, OR: 2.2 [1.27-3.83] p=0.004) with a simultaneous drastic reduction of miscarriages per initiated pregnancy (17.9% versus 43.2%, OR: 0.29 [0.12-0.71], p=0.005). 22% of analyzed patients had no dysregulation. They did not differ from their matched controls for LBR and miscarriages. CONCLUSION: Uterine immune profiling enables an integrated approach of infertility that includes endometrial immunity as a key factor in planning personalized IVF/ICSI treatments. Personalization of treatment according to the woman's uterine immune balance produced a very significantly higher LBR.
BACKGROUND: Embryo implantation remains the main limiting factor in IVF/ICSI program. Endometrial immune remodeling events begin before implantation and are a vital process for pregnancy, preparing future maternal immune tolerance and regulating the placentation process. METHODS: Between 2012 and 2014, 193 patients (analyzed group) enrolled in our IVF program benefitted of an endometrial immune profiling to determine if their uterus was immunologically ready to accept an embryo and, if not, the specific immune mechanisms involved. Subsequently, they had an effective embryo transfer (ET) with personalization of their treatments if an immune deregulation has been diagnosed. Each analyzed patient was paired to the closest patient included in the IVF program according to biological criteria (age, number of mature oocytes, stage and number of transferred embryo), which had no endometrial immune profiling (193 patients, non-analyzed group). FINDING: 78% of analyzed patients had a uterine immune dysregulation and therefore care personalization. Their corresponding live birth rate (LBR) was twice higher than observed in the matched control group with conventional cares (30.5% versus 16.6%, OR: 2.2 [1.27-3.83] p=0.004) with a simultaneous drastic reduction of miscarriages per initiated pregnancy (17.9% versus 43.2%, OR: 0.29 [0.12-0.71], p=0.005). 22% of analyzed patients had no dysregulation. They did not differ from their matched controls for LBR and miscarriages. CONCLUSION: Uterine immune profiling enables an integrated approach of infertility that includes endometrial immunity as a key factor in planning personalized IVF/ICSI treatments. Personalization of treatment according to the woman's uterine immune balance produced a very significantly higher LBR.
Authors: Jelmer R Prins; Floor Holvast; Janneke van 't Hooft; Arend F Bos; Jan Willem Ganzevoort; Sicco A Scherjon; Sarah A Robertson; Sanne J Gordijn Journal: BMJ Open Date: 2018-08-05 Impact factor: 2.692