The uterine immune profile: A method for individualizing the management of women who have failed to implant an embryo after IVF/ICSI.

A unique endometrial immune reaction should occur to promote the human embryo implantation. We postulated that an immune disequilibrium may impact the initial dialogue between the mother and her embryo. In 2012, we set a method of uterine immune profiling for patients with unexplained repeated implantation failures (RIF). The method documents the local Th-1/ Th-2 equilibrium and the recruitment and state of maturation/activation of uNK cells. In function of the disequilibrium observed, personalization of assisted reproductive treatments was suggested. As the concept of personalization in function of the uterine immune profile had never been proposed, a large cohort study and a controlled cohort study were first conducted in RIF patients. 80 % of the RIF patients showed a local disequilibrium if compared to fertile controls. The local disequilibrium was identified in 3 categories: over-immune activation in 45 %, low- local immune activation in 25 % and mixed profile in 10 %. Personalization of treatments in function of the immune profile allowed to restore a live birth rate by 40 % at the following embryo transfer. RIF patients with endometriosis show some particularities regarding their immune profiles. We also suggested that immunotherapy (corticoids, intralipids) may have targeted indications based on a better understanding of the immune type of disequilibrium documented. Personalization of treatments for RIF patients seems to be essential to promote the subsequent live birth rate. The endometrial immune profiling is an innovative method aiming to detect a local immune disequilibrium and, if present, to test preventively its correction under treatment.

[Surgical management of intrauterine adhesions: is benefice bigger than risk?]. / Synéchie utérine: le jeu chirurgical en vaut-il la chandelle?

Management of intrauterine synechiae in a context of infertility remains a challenge, in spite of hysteroscopic microsurgery progress. There is no published prospective study to be used as a guideline. Anatomic, but most of all functional prognosis are directly correlated to the severity of adhesions and the number of surgical procedures required to complete treatment. Complications during surgery are not infrequent, but are well known and often benign. Obstetrical complications are much less frequent but often severe (abnormal placentation, uterine rupture). Recurrences are common enough to impose a systematic second-look diagnostic hysteroscopy. However, the benefit gained by the recovery of fertility (either spontaneous or not) remains superior, in my opinion, to the risks of the surgical management.