Endometrial receptivity (ER) is a key factor required for the successful implantation of the embryo. However, the evaluation of ER is challenging, as a nondisruptive sampling of endometrial biomaterial by conventional methods is only possible outside of the embryo transfer (ET) cycle. We propose a novel approach for the assessment of ER—microbiological and cytokine profiling of menstrual blood aspirated directly from the uterine cavity at the beginning of the cryo-ET cycle. The aim of the pilot study was to evaluate its prognostic potential regarding the outcome of the in vitro fertilization procedure. Samples collected from a cohort of 42 patients undergoing cryo-ET were analyzed by a multiplex immunoassay (48 various cytokines, chemokines, and growth factors) and a real-time PCR assay (28 relevant microbial taxa and 3 members of the Herpesviridae family). Significant differences between groups of patients who achieved and did not achieve pregnancy were observed for G-CSF, GRO-α, IL-6, IL-9, MCP-1, M-CSF, SDF-1α, TNF-β, TRAIL, SCF, IP-10, and MIG (p < 0.05), whereas microbial profiles were not associated with the outcome of cryo-ET. It appeared that levels of IP-10 and SCGF-β were significantly lower (p < 0.05), in patients with endometriosis. Menstrual blood may provide great opportunities to noninvasively investigate various parameters of the endometrium.

Background. The field of medicine that studies the possibility of preserving reproductive function in cancer patients is intensively developing in the world. Many countries are studying this issue by creating their own databases and national guidelines. In Russia, despite the interest in this problem and discussions at many national conferences, there are no national programs, protocols and clinical recommendations. It creates an obstacle to receiving this type of care for cancer patients. In this regard, the creation of an interdisciplinary system on the preservation of reproductive function in cancer patients becomes relevant. Aim. Formation of interdisciplinary relations between oncologists / hematologists, obstetricians-gynecologists and fertility doctors in order to improve the effectiveness of the care provided on fertility preservation in cancer patients. Materials and methods. The study involved oncologists from the S. S. Yudin City Clinical Hospital, Moscow Healthcare Department, obstetricians-gynecologists and hematologists from the City Clinical Hospital No. 52, Moscow Healthcare Department, as well as reproductive health specialists from the Institute of Reproductive Medicine REMEDI. Oncological patients were recruited on the basis of the S. S. Yudin City Clinical Hospital. A standard scope of examination was undertaken and they were offered antitumor treatment within the framework of the tumor board, taking into account the stage of the disease and the morphological type of the tumor. An obstetrician-gynecologist received patients on the basis of the City Clinical Hospital No. 52. An individual card specially designed for this study was filled in for each patient. The card included data on anamnesis, examination and additional examination methods. A reproductive health specialist received patients on the basis of the Institute of Reproductive Medicine REMEDI. The information obtained during the consultations was added into the specially designed cancer fertility register, with a subsequent assessment of each patient’s status. Results. A multidisciplinary team on fertility preservation was formed with a clear routing of cancer patients when referring to appropriate specialists. Since 2023, 42 oncological and hematological patients have been consulted. A unified database on oncofertility was set up.Conclusion. Our study confirms the need to create a multidisciplinary team to address the issues of preserving reproductive function in cancer patients, providing adequate information to patients about the risks of developing premature ovarian failure during treatment, about possible options for preserving fertility, improving the quality of life and the likelihood of childbirth after the completion of antitumor treatment.

Background: There is growing evidence that uterine microbiota might be linked to endometrial receptivity (ER) and affect the outcome of assisted reproductive technology (ART) procedures. Owing to the invasive nature of endometrial sampling, the evaluation of microbiota in this biomaterial is only possible outside the embryo transfer (ET) cycle. However, menstrual blood might be the key to overcoming this challenge as it can be safely aspirated from the uterine cavity at the beginning of the target ET cycle. This study aimed to evaluate the association of the microbiological profiles of menstrual blood with ER in patients undergoing frozen ET. Methods: Menstrual blood was obtained from 98 individuals scheduled for frozen ET in a private ART clinic (ET success rate–50%). DNA was isolated from menstrual sediment and analyzed using a multiplex quantitative PCR assay designed to identify 28 relevant microbial taxa and 3 Herpesviridae viruses. Results: Bacterial DNA was detected in 75.5% of samples. There were no associations between the abundance of individual microbial taxa and the outcome of ET, and the same was true for Shannon’s α-diversity indices (p > 0.05). However, Candida spp. and Enterobacteriaceae were detected exclusively in patients with negative ET outcomes (p = 0.028). Individuals with recurrent implantation failure had a significantly lower abundance of Lactobacillus spp. than the rest (0.0 [0.0; 7.4] vs. 2.8 [0.0; 91.9] %, p = 0.024). Conclusions: Menstrual blood aspirated directly from the uterus is a promising biomaterial for endometrial microbiological profiling. Upon further investigation, its analysis might become a useful tool in managing infertile patients scheduled for ART treatment.

BACKGROUND: Endometrial receptivity disorders are the primary focus in patients with repeated implantation failure. However, the cellular and receptor characteristics of endometrial mesenchymal stromal cells in this population remain poorly understood, especially in terms of proliferative activity and estrogen receptor expression. This work examined the proliferative activity and expression of estrogen receptors in endometrial mesenchymal stromal cells in these patients to identify a new pathogenetic link of infertility and potential therapeutic targets. AIM: The work aimed to assess the functional characteristics of endometrial mesenchymal stromal cells, including their proliferative activity and estrogen receptor expression, in patients with repeated failure of euploid embryo implantation. METHODS: This pilot study included five patients aged 25–40 years. The main group included four patients with repeated implantation failure. An endometrial sample from a surrogate mother with a history of six term births served as a positive control. Mesenchymal stromal cells were isolated from endometrial aspiration biopsy samples collected during the first phase of the menstrual cycle. ESR1 expression was assessed by real-time polymerase chain reaction, and estrogen receptor alpha (ERα) levels were measured by fluorescent immunocytochemistry. The proliferative activity of mesenchymal stromal cells was assessed in the IncuCyte live-cell analysis system in a control medium and with 0.1 nM 17β-estradiol. RESULTS: ESR1 mRNA levels in cultured endometrial mesenchymal stromal cells were approximately 10 times higher than in adipose tissue mesenchymal stromal cells. Immunocytochemistry revealed specific expression of nuclear ERα in all samples. Patients with unexplained infertility had fewer receptors than the control group, with the lowest ERα expression reported in patients with tubal-peritoneal infertility. Endometrial mesenchymal stromal cells from patients with repeated implantation failure had a significantly lower proliferation rate than mesenchymal stromal cells from a surrogate mother. Patients with unexplained infertility had the lowest proliferative capacity of endometrial mesenchymal stromal cells. Adding 17β-estradiol significantly increased endometrial mesenchymal stromal cell proliferation in both the surrogate mother and patients with unexplained infertility. In patients with tubal-peritoneal infertility, 0.1 nM estradiol did not improve endometrial mesenchymal stromal cells proliferation. CONCLUSION: This work is the first to demonstrate decreased proliferative activity and expression of estrogen receptors (ERα) in endometrial mesenchymal stromal cells in patients with repeated implantation failure. The findings indicate that mesenchymal stromal cells from patients with unexplained infertility remain sensitive to estrogen despite the reduced number of receptors. These data add to a better understanding of the functional characteristics of endometrial mesenchymal stromal cells in repeated implantation failure.

Background. Over the past few decades, the advancements in antitumor therapy, early diagnosis, and the development of stem cell transplantation techniques have led to a notable increase in the survival rates of oncohematological patients. Although effective chemotherapy has been shown to prolong lifespan, it can also contribute to toxic effects on gland function, which in women can result in impaired fertility and hormonal disorders related to sex hormone production. In order to mitigate or prevent the irreversible complications of antitumor therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate a variety of options for preserving and restoring fertility should be implemented prior to, during, and following the chemotherapy or radiotherapy.Aim. To test in clinical practice the principles of creating a management plan for oncohematological patients of reproductive age prior to starting special treatment.Materials and methods. The study included 34 female patients of reproductive age with morphologically confirmed hematological diseases who underwent examination, treatment, and follow-up observation at the State Budgetary Healthcare Institution, City Clinical Hospital No. 52 of the Moscow Healthcare Department. All patients were referred for consultation with an obstetrician-gynecologist to evaluate their hormonal status and reproductive potential. Additionally, a multidisciplinary team, including a reproductive health specialist from REMEDI Institute of Reproductive Medicine LLC, assessed ovarian reserve and selected appropriate fertility preservation technique. A comprehensive review and discussion of all clinical cases was conducted within the framework of a multidisciplinary team, leading to a determination of the feasibility of fertility preservation.Results. The material for fertility preservation was collected in 82 % of the patients. Hodgkin’s lymphoma was the most common malignancy (76 %). The methods employed for material collection included transvaginal follicle puncture following controlled ovarian stimulation in 89 % of cases and laparoscopy with ovarian resection / ovariectomy followed by cryopreservation of ovarian tissue in 11 % of cases. The fertility preservation methods included oocyte cryopreservation in 71 % of cases, embryo cryopreservation in 11 % of cases, ovarian tissue cryopreservation in 11 % of cases, and both oocyte and embryo cryopreservation in the remaining 7 % of cases. No complications were reported following assisted reproductive technology procedures.Conclusion. Given the importance of reproductive potential and overall survival in the context of oncohematological diseases, reproductive specialists should prioritize selecting a fertility preservation method before initiating specialized treatment in all patients of reproductive age. The opportunity to procreate constitutes a pivotal component of quality of life for this particular patient population.