• Clinical and Experimental Reproductive Medicine
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• v.25 no.1
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• pp.51-58
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• 1998

본 연구는 체외수정 프로그램에 참여하는 환자에 있어서 난자회수 이틀째의 자궁내막의 발달상태를 알아보기 위하여 pinopode의 발달상태, 에스트로젠 및 프로제스테론 수용체의 발현을 관찰하였다. 생검한 자궁내 막 조직 을 양분하여, 절반은 전사전자 현미경 (scanning electron microscope)으로 pinopode를 관찰하기 위하여 2.5% glutaraldehyde와 2% paraformaldehyde로 고정하였고, 나머지 절반은 dating 및 스테로이드 수용체의 면역조직화학적 측정 (immunocytochemistry)을 위하여 10% formalin으로 고정하였다. 모두 12명의 환자중 8명에서 pinopode가 관찰되었으며, pinopode 발달이 관찰되지 않은 환자들은 hCG 주사를 맞는 날의 estradiol (E2)의 혈중농도가 600 pg/mL이하로 낮았다. 본 연구의 결과로부터 자궁내막의 발달상태를 알아보기 위해서는 지금까지 일반적으로 사용되어 오던 dating이나 스테로이드 수용체의 면역조직화학적 측정법 이외에도 pinopode를 관찰함으로써 조금 더 정확한 진단을 할 수 있으리라고 사료되며, pinopode의 발달은 E2의 혈중농도와 관계가 있을 것으로 추정된다.

• Development and Reproduction
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• v.13 no.1
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• pp.1-11
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• 2009

Implantation itself is governed by an array of endocrine, paracrine and autocrine modulators, of embryonic and maternal origin. Window of implantation is the unique temporal and spatial expression of factors allows the embryo to implant via signaling, appositioning, attachment, and invasion in a specific time frame of $2{\sim}4$ days. When the embryo has arrived in the uterine cavity, a preprogrammed sequence of events occurs, which involves the production and secretion of a multitude of biochemical factors such as cytokines, growth factors, and adhesion molecules by the endometrium and the embryo, thus leading to the formation of a receptive endometrium. Cytokines such as LIF, CSF-1, and IL-1 have all been shown to play important roles in the cascade of events that leads to implantation. Integrin, L-selectin ligands, glycodelin, mucin-1, HB-EGF and pinopodes are involved in appositioning and attachment. The embryo also produces cytokines and growth factors (ILs, VEGF) and receptors for endometrial signals such as LIF, CSF-1, IGF and HB-EGF. The immune system and angiogenesis play an important role. The usefulness of these factors to assess endometrial receptivity and to estimate the prognosis for pregnancy in natural and artificial cycles remains to be proven. Integrins, pinopodes, glycodelin and LIF (from biopsies) are promising candidates; from uterine flushings, glycodelin and LIF are also candidates. The ideal serum marker is not available, but VEGF, glycodelin and CSF have some clinical implications. Further evaluation that includes larger groups of infertile women and fertile controls are needed to elucidate whether their presence in plasma, flushing fluid, or endometrial samples can be used as some kind of a screening tool to assess endometrial function and prognosis for pregnancy before and after artificial reproductive therapy. A better understanding of their function in human implantation may lead to therapeutic intervention, thereby improving the success rate in reproduction treatment. New molecular techniques are becoming available for measuring both embryonic and endometrial changes prior to and during implantation. The use of predictive sets of markers may prove to be more reliable than a single marker. Ultimately, the aim is to use these tools to increase implantation in artificial cycles and consequently improve live-birth rates.