Physician Focus Concurrent Session: Endometriosis & Implantation Debate, Recurrent Implantation Failure & Endometrial Immunologic Factors, Oocyte Donation: Historical perspective and lesson learned

Date Saturday, April 6, 2019
Time 10:10am - 12:30pm
Location Esmeralda 1-4

"Endometriosis & Implantation debate" - Bruce Lessey, MD, PhD vs. Paola Vigano, MD
Implantation and Endometriosis: lessons learnt from ART
Many studies on endometriosis have under-estimated the impact of endometriosis on endometrial receptivity and fertility. Endometriosis is the basis for many if not the majority of IVF failures around the world. Not only are laparoscopies for endometriosis not being performed before IVF, most women with the diagnosis have already been treated for the disease, while the untreated majority are not counted. This fundamental flaw in how we study endometriosis has lead to the abandonment of treatment for this disease. As result IVF success rates in terms of live birth rate, even with transfer of normal embryos, remains below 50% in most centers. In addition, miscarriages in the setting of IVF due to endometriosis have not been appreciated. Using specific biomarkers, women with endometriosis can be identified early allowing far greater success. These studies not only provide evidence for the mechanism of endometriosis-related sub fertility, but also suggests treatment strategies that will change the future of infertility treatment.

1. Review the concept of implantation
2. Analyze the different hypothetical causes of implantation failure in endometriosis patients
3. Present clinical evidence to understand where is the problem in women with endometriosis and implantation failure

Timing isn’t everything: Endometriosis and Defects in Implantation
1. Review the definition of endometrial receptivity
2. Explain the role of inflammation in normal implantation and defects in endometrial receptivity
3. Review the changes in signaling pathways for discovery of biomarkers of endometriosis

"Recurrent Implantation Failure & Endometrial Immunologic Factors" - Carolyn Coulam, MD
A rational approach to the problem of recurrent implantation failure (RIF)
Both courts and legislatures are increasingly faced with- and responding to-- novel ART related challenges. This talk will highlight recent embryo related disputes, 3rd party ART legal issues, as well as legislative responses, and suggest ways providers and patients can practice safer ART.
1. To understand the mechanisms involved involve in the different causes of RIF
2. To learn diagnostic tools available to identify the cause of RIF
3. To be aware of appropriate options for treatment of RIF since not all implantation failures occur for the same reason

"Oocyte donation: historical perspective and lessons learned" - Richard Paulson, MD
This presentation will review the development of oocyte donation, which marked the advent of 3rd party parenting.
Preparation of the recipient endometrium was a necessary part of oocyte donation, but its application has now been generalized to gestational surrogacy, and most commonly, to frozen embryo transfer cycles. "Synchronization of the endometrium" originally referred to the synchronization of donor and recipient cycles, but now applies increasingly to synchronization with the embryonic developmental stage.
1. To describe the development of oocyte donation
2. To understand the concept of endometrial receptivity
3. To counsel patients about optimal timing of embryo transfer

"Endometrial receptivity in patients with endometriosis is NOT affected and let me show you why" - Paola Vigano, PhD

1. To understand the difference in cellular activity at the implantation site with and without endometriosis
2. To understand the differences in endometrial specific gene expression profile at the implantation site with and without endometriosis
3. To understand the differences in endometrial genome-wide transcriptomic signature at the implantation with and without endometriosis


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