Therapeutic intervention of endometrial pathology before ovarian stimulation

Abstract

Successful pregnancy occurs only if the development of oocytes is accompanied by parallel development of endometrium which is receptive once the fertilized embryo reaches the endometrial cavity and further synchronizes with the development of the embryo by undergoing complex series of decidualization. This forms a chain of complex events taking place in the endometrium. Knowledge about endometrial receptivity is still limited, and where needed, interventions can improve infertility outcome. This may be in the form of removing endometrial polyps, resection of sub-mucous fibroids, treatment of endometritis, resection of uterine septum and uterine adhesions and hormonal manipulation of the endometrial milieu using estrogen therapy, sildenafil, aspirin, pentoxifyline and vitamin E. Women with polycystic ovaries also need treatment of endometrium, which may be hostile under the influence of high androgens or due to excessive stimulation under estrogen therapy and harbour hyperplasia or endometrial carcinoma. Similarly, women with endometriosis have luteal phase deficit and therefore may have irregular bleeding. Stem cell therapy is emerging as a new hope for women with damaged endometrium as a result of Asherman syndrome.