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Chapter 5 - Conception

from Section 1 - Physiology of Reproduction

Published online by Cambridge University Press:  05 March 2021

Edited by
Eliezer Girsh
Eliezer Girsh
Affiliation:
Barzilai Medical Center, Ashkelon
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Summary

Cervical mucus is a regulator of the sperm transfer from the vagina to the uterine cavity. Estradiol (E2) stimulates the production of large amounts of thin, watery, alkaline acellular cervical mucus with ferning, spinnbarkeit (crystallization), and sperm receptivity. Progesterone (P4) inhibits the secretory activity of cellular mucus and produces low spinnbarkeit and absence of ferning, which is impenetrable by spermatozoa. In midcycle, the cervix softens progressively, the os of the cervical canal dilates, and clear, profuse mucus exudes from the external os. In a few days after ovulation, the cervix becomes firm, and the os closes. The cervix is the first barrier for the sperm to overcome.

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A Textbook of Clinical Embryology , pp. 56 - 70
Publisher: Cambridge University Press
Print publication year: 2021

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References

Sobrero, AJ, Macleod, J. The immediate postcoital test. Fertil. Steril. 1962; 13:184–189.CrossRefGoogle ScholarPubMed
Pacey, AA, Hill, CJ, Scudamore, IW, et al. The interaction in vitro of human spermatozoa with epithelial cells from the human uterine (fallopian) tube. Hum. Reprod. 1995; 10:360–366.CrossRefGoogle ScholarPubMed
Hunter, RHF, Petersen, HH, Greve, T. Ovarian follicular fluid, progesterone and Ca2+ ion influences on sperm release from the Fallopian tube reservoir. Mol. Reprod. Dev. 1999; 54:283–291.Google Scholar
Sun, F, Bahat, A, Gakamsky, A, et al. Human sperm chemotaxis: both the oocyte and its surrounding cumulus cells secrete sperm attractants. Hum. Reprod. 2005; 20:761–767.CrossRefGoogle Scholar
Talbot, P. Sperm penetration through oocyte investments in mammals. Am. J. Anat. 1985; 174:331–346.Google Scholar
Drobnis, EZ, Katz, DF. Videomicroscopy of mammalian fertilization. In: Wassarman, PM, ed., Elements of Mammalian Fertilization. Boca Raton: CRC Press. 1991; 269–300.Google Scholar
Nomikos, M, Kashir, J, Swann, K, Lai, FA. Sperm PLCζ: from structure to Ca2+ oscillations, egg activation and therapeutic potential. FEBS Lett. 2013; 587:3609–3616.CrossRefGoogle ScholarPubMed
Sutovski, P, Moreno, RD, Ramalho-Santos, J, et al. Ubiquitin tag for sperm mitochondria. Nature 1999; 402:371–372.CrossRefGoogle Scholar
Navot, D, Scott, RT, Droesch, K, et al. The window of embryo transfer and the efficiency of human conception in vitro. Fertil. Steril. 1991; 55:114–118.Google Scholar
Duc-Goiran, P, Mignot, TM, Bourgeois, C, Ferré, F. Embryo-maternal interactions at the implantation site: a delicate equilibrium. Eur. J. Obstet. Gynecol. Reprod. Biol. 1999; 83:85–100.Google Scholar
Lessey, BA. The role of the endometrium during embryo implantation. Hum. Reprod. 2000; 15:39–50.Google Scholar
Edwards, RG. Implantation, interception and contraception. Hum. Reprod. 1994; 9:985–995.Google Scholar
Franasiak, JM, Forman, EJ, Hong, KH, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15 169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil. Steril. 2014; 101:656–663.CrossRefGoogle Scholar
Adams, SM, Gayer, N, Hosie, MJ, Murphy, CR. Human uterodomes (pinopods) do not display pinocytotic function. Hum. Reprod. 2002; 17:1980–1986.Google Scholar
Nikas, G, Drakakis, P, Loutradis, D, et al. Uterine pinopodes as markers of “nidation window” in cycling women receiving exogenous oestradiol and progesterone. Hum. Reprod. 1995; 10:1208–1213.Google Scholar
Licht, P, von Volff, M, Berkholz, A, Wildt, L. Evidence for cycle-dependent expression of full-length human chorionic gonadotropin/luteinizing hormone receptor mRNA in human endometrium and decidua. Fertil. Steril. 2003; 79:718–723.Google Scholar
Nikas, G, Aghajanova, L. Endometrial pinopodes: some more understanding on human implantation? RBM Online 2002; 4:18–23.Google Scholar
Macklon, NS, Brosens, JJ. The human endometrium as a sensor of embryo quality. Biol. Reprod. 2014; 91:98.Google Scholar
Wilcox, AJ, Baird, DD, Weinberg, CR. Time of implantation of the conceptus and loss of pregnancy. N. Engl. J. Med. 1999; 340:1796–1799.Google Scholar
Bentin-Ley, U. Relevance of endometrial pinopodes for human blastocyst implantation. Hum. Reprod. 2000; 15:67–73.Google Scholar
Aplin, JD, Ruane, PT. Embryo-epithelium interactions during implantation at a glance. J. Cell Sci. 2017; 130:15–22.Google Scholar
Feng, Y, Ma, X, Deng, L, et al. Role of selectins and their ligands in human implantation stage. Glycobiology 2017; 27:385–391.Google Scholar
Genbacev, OD, Prakobphol, A, Foulk, RI, et al. Trophoblast L-selectin-mediated adhesion at the maternal-fetal interface. Science 2003; 299:405–408.Google Scholar
Soygur, B, Moore, H. Expression of syncytin 1 (HERV-W), in the preimplantation human blastocyst, embryonic stem cells and trophoblast cells derived in vitro. Hum. Reprod. 2016; 31:1455–1461.Google Scholar
Mori, M, Bogdan, A, Balassa, T, Csabai, T, Szekeres-Bartho, J. The decidua—the maternal bed embracing the embryo—maintains the pregnancy. Semin. Immunopathol. 2016; 38:635–649.CrossRefGoogle ScholarPubMed
Liu, S, Diao, L, Huang, C, et al. The role of decidual immune cells on human pregnancy. J. Reprod. Immunol. 2017; 124:44–53.CrossRefGoogle ScholarPubMed
Han, SW, Lei, ZM, Rao, CV. Treatment of human endometrial stroma cells with chorionic gonadotropin promotes their morphological and functional differentiation into decidua. Mol. Cell. Endocrinol. 1999; 147:7–16.Google Scholar
Yang, M, Lei, ZM, Rao, CV. The central role of human chorionic gonadotropin in the formation of human placental syncytium. Endocrinology 2003; 144:1108–1120.Google Scholar
Casper, RF. Basic understanding of gonadotropin-releasing hormone-agonist triggering. Fertil. Steril. 2015; 103:867–869.Google Scholar
Fournier, T, Guibourdenche, J, Evain-Brion, D. Review: hCGs: different sources of production, different glycoforms and functions. Placenta 2015; 36:S60–S65.Google Scholar
Sivalingam, VN, Duncan, WC, Kirk, E, Shephard, LA, Horne, AW. Diagnosis and management of ectopic pregnancy. J. Fam. Plann. Reprod. Health Care 2011; 37:231–240.CrossRefGoogle ScholarPubMed
Tuckey, RC. Progesterone synthesis by the human placenta. Placenta 2005; 26:273–281.CrossRefGoogle ScholarPubMed
Illingworth, PJ, Reddi, K, Smith, K, Baird, DT. Pharmacological “rescue” of the corpus luteum results in increased inhibin production. Clin. Endocrinol. (Oxf). 1990; 33:323–332.CrossRefGoogle ScholarPubMed
Duffy, DM, Stouffer, RL. Gonadotropin versus steroid regulation of the corpus luteum of the rhesus monkey during simulated early pregnancy. Biol. Reprod. 1997; 57:1451–1460.Google Scholar
Yoshimi, T, Strott, CA, Marshall, JR, Lipsett, MB. Corpus luteum function in early pregnancy. J. Clin. Endocrinol. 1969; 29:225–230.Google Scholar
Nakajima, ST, Nason, FG, Badger, GJ, Gibson, M. Progesterone production in early pregnancy. Fertil. Steril. 1991; 55:516–521.Google Scholar
Gagliardi, CL, Goldsmith, LT, Saketos, M, Weiss, G, Schmidt, CL. Human chorionic gonadotropin stimulation of relaxin secretion by luteinized human granulosa cells. Fertil. Steril. 1992; 58:314–320.Google Scholar
Conrad, KP. Maternal vasodilation in pregnancy: the emerging role of relaxin. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2011; 301:R267–R275.Google Scholar
Craciunas, L, Gallos, I, Chu, J, et al. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum. Reprod. Update 2019; 25:202–223, doi:10.1093/humupd/dmy044.Google Scholar
Balasch, J, Fábregues, F, Creus, M, Vanrell, JA. The usefulness of endometrial biopsy for luteal phase evaluation in infertility. Hum. Reprod. 1992; 7:973–977.Google Scholar
Pantos, K, Nikas, G, Makrakis, E, et al. Clinical value of endometrial pinopodes detection in artificial donation cycles. RBM Online 2004; 9:86–90.Google Scholar
Jin, XY, Zhao, LJ, Luo, DH, et al. Pinopode score around the time of implantation is predictive of successful implantation following frozen embryo transfer in hormone replacement cycles. Hum. Reprod. 2017; 32:2394–2403.Google Scholar
Díaz-Gimeno, P, Horcajadas, JA, Martínez-Conejero, JA, et al. A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature. Fertil. Steril. 2011; 95:50–60.Google Scholar
Hashimoto, T, Koizumi, M, Doshida, M, et al. Efficacy of the endometrial receptivity array for repeated implantation failure in Japan: a retrospective, two-centers study. Reprod. Med. Biol. 2017; 16:290–296.Google Scholar
Tan, J, Kan, A, Hitkari, J, et al. The role of the endometrial receptivity array (ERA) in patients who have failed euploid embryo transfers. J. Assist. Reprod. Genet. 2018; 35:683–692.CrossRefGoogle ScholarPubMed
Wang, J, Xia, F, Zhou, Y, et al. Association between endometrial/subendometrial vasculature and embryo transfer outcome: a metaanalysis and subgroup analysis. J. Ultrasound Med. 2018; 37:149–163.Google Scholar
Simón, C, Martin, JC, Pellicer, A. Paracrine regulators of implantation. Baillieres Best Pract. Res. Clin. Obstet. Gynaecol. 2000; 14:815–826.CrossRefGoogle ScholarPubMed
Aghajanova, L, Stavrèus-Evers, A, Nikas, Y, Hovatta, O, Landgren, BM. Coexpression of pinopodes and leukemia inhibitory factor, as well as its receptor, in human endometrium. Fertil. Steril. 2003; 79:808–814.Google Scholar
Lindhard, A, Bentin-Ley, U, Ravn, V, et al. Biochemical evaluation of endometrial function at the time of implantation. Fertil. Steril. 2002; 78:221–233.Google Scholar
Stavrèus-Evers, A, Aghajanova, L, Brismar, H, et al. Co-existence of heparin-binding epidermal growth factor-like growth factor and pinopodes in human endometrium at the time of implantation. Mol. Hum. Reprod. 2002; 8:765–769.Google Scholar
Daiter, E, Pampfer, S, Yeung, YG, et al. Expression of colony stimulating factor-1 in the human uterus and placenta. J. Clin. Endocrinol. Metab. 1992; 74:850–858.Google Scholar
Licht, P, Russu, V, Lehmeyer, S, et al. Intrauterine microdialysis reveals cycle-dependent regulation of endometrial insulin-like growth factor binding protein-1 secretion by human chorionic gonadotrophin. Fertil. Steril. 2002; 78:252–258.Google Scholar
Slayden, OD, Rubin, JS, Lacey, DL, Brenner, RM. Effects of keratinocyte growth factor in the endometrium of rhesus macaques during the luteal-follicular transition. J. Clin. Endocrinol. Metab. 2000; 85:275–285.Google Scholar
Tei, C, Maruyama, T, Kuji, N, et al. Reduced expression of alphavbeta3 integrin in the endometrium of unexplained infertility patients with recurrent IVF-ET failures: improvement by danazol treatment. J. Assist. Reprod. Genet. 2003; 20:13–20.Google Scholar
Bischof, P. Endocrine, paracrine and autocrine regulation of trophoblastic metalloproteinases. Early Pregnancy 2001; 5:30–31.Google Scholar
Xu, P, Wang, YL, Zhu, SJ, et al. Expression of matrix metalloproteinase-2, -9, and -14, tissue inhibitors of metalloproteinase-1, and matrix proteins in human placenta during the first trimester. Biol. Reprod. 2000; 62:988–994.Google Scholar
Nguyen, HPT, Simpson, RJ, Salamonsen, LA, Greening, DW. Extracellular vesicles in the intrauterine environment: challenges and potential functions. Biol. Reprod. 2016; 95:109.Google Scholar
Gross, N, Kropp, J, Khatib, H. MicroRNA signaling in embryo development. Biology (Basel) 2017; 6:34.Google ScholarPubMed
Chegini, N, Tang, XM, Dou, Q. The expression, activity and regulation of granulocyte macrophage-colony stimulating factor in human endometrial epithelial and stromal cells. Mol. Hum. Reprod. 1999; 5:459–466.CrossRefGoogle ScholarPubMed
Paiva, P, Hannan, NJ, Hincks, C, et al. Human chorionic gonadotrophin regulates FGF2 and other cytokines produced by human endometrial epithelial cells, providing a mechanism for enhancing endometrial receptivity. Hum. Reprod. 2011; 26:1153–1162.Google Scholar
Sjöblom, C, Roberts, CT, Wikland, M, Robertson, SA. Granulocyte-macrophage colony-stimulating factor alleviates adverse consequences of embryo culture on fetal growth trajectory and placental morphogenesis. Endocrinology 2005; 146:2142–2153.Google Scholar
Robertson, SA, Roberts, CT, Farr, KL, Dunn, AR, Seamark, RF. Fertility impairment in granulocyte-macrophage colony-stimulating factor-deficient mice. Biol. Reprod. 1999; 60:251–261.Google Scholar
Perez-Garcia, V, Fineberg, E, Wilson, R, et al. Placentation defects are highly prevalent in embryonic lethal mouse mutants. Nature 2018; 555:463–468.Google Scholar
Hemberger, M, Hanna, CW, Dean, W. Mechanisms of early placental development in mouse and humans. Nat. Rev. Genet. 2019; 21:27–43. doi:10.1038/s41576-019–0169-4.Google Scholar
Noyes, RW, Hertig, AT, Rock, J. Dating the endometrial biopsy. Fertil. Steril. 1950; 1:3–25.CrossRefGoogle Scholar
Pijnenborg, R, Vercruysse, L, Hanssens, M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 2006; 27:939–958.CrossRefGoogle ScholarPubMed
Malassine, A, Frendo, J-L, Evain-Brion, D. A comparison of placental development and endocrine functions between the human and mouse model. Hum. Reprod. Update 2003; 9:531–539.Google Scholar
Jarvela, IY, Ruokonen, A, Tekay, A. Effect of rising hCG levels on the human corpus luteum during early pregnancy. Hum. Reprod. 2008; 23:2775–2781.Google Scholar
Gamliel, M, Goldman-Wohl, D, Isaacson, B, et al. Trained memory of human uterine NK cells enhances their function in subsequent pregnancies. Immunity 2018; 48:951–962.Google Scholar
Hanna, J, Goldman-Wohl, D, Hamani, Y, et al. Decidual NK cells regulate key developmental processes at the human fetal-maternal interface. Nat. Med. 2006; 12:1065–1074.Google Scholar
Kalkunte, SS, Mselle, TF, Norris, WE, et al. Vascular endothelial growth factor C facilitates immune tolerance and endovascular activity of human uterine NK cells at the maternal-fetal interface. J. Immunol. 2009; 182:4085–4092.CrossRefGoogle ScholarPubMed
Klentzeris, LD, Bulmer, JN, Warren, MA, et al. Lymphoid tissue in the endometrium of women with unexplained infertility: morphometric and immunohistochemical aspects. Hum. Reprod. 1994; 9:646–652.Google Scholar
Hunt, JS, Miller, L, Platt, JS. Hormonal regulation of uterine macrophages. Dev. Immunol. 1998; 6:105–110.Google Scholar
Bulmer, JN, Williams, PJ, Lash, GE. Immune cells in the placental bed. Int. J. Dev. Biol. 2010; 54:281–294.CrossRefGoogle ScholarPubMed
Abrahams, VM, Kim, YM, Straszewski, SL, Romero, R, Mor, G. Macrophages and apoptotic cell clearance during pregnancy. Am. J. Reprod. Immunol. 2004; 51:275–282.Google Scholar
Jiang, TT, Chaturvedi, V, Ertelt, JM, et al. Regulatory T cells: new keys for further unlocking the enigma of fetal tolerance and pregnancy complications. J. Immunol. 2014; 192:4949–4956.Google Scholar
Fisher, SJ. Why is placentation abnormal in preeclampsia? Am. J. Obstet. Gynecol. 2015; 213:S115–S122.Google Scholar
Hunt, JS, Petroff, MG, McIntire, RH, Ober, C. HLA-G and immune tolerance in pregnancy. FASEB J. 2005; 19:681–693.Google Scholar
Helige, C, Ahammer, H, Hammer, A, et al. Trophoblastic invasion in vitro and in vivo: similarities and differences. Hum. Reprod. 2008; 23:2282–2291.Google Scholar
Maltepe, E, Fisher, SJ. Placenta: the forgotten organ. Annu. Rev. Cell Dev. Biol. 2015; 31:523–552.Google Scholar
Chetty, M, Duncan, WC. Investigation and management of recurrent miscarriage. Obstet. Gynecol. Reprod. Med. 2015; 25:31–36.CrossRefGoogle Scholar
Lucas, ES, Dyer, NP, Murakami, K, et al. Loss of endometrial plasticity in recurrent pregnancy loss. Stem Cells 2016; 34:346–356.Google Scholar
Sotiriadis, A, Makrigiannakis, A, Stefos, T, Paraskevaidis, E, Kalantaridou, SN. Fibrinolytic defects and recurrent miscarriage: a systematic review and meta-analysis. Obstet. Gynecol. 2007; 109:1146–1155.Google Scholar

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  • Conception
  • Edited by Eliezer Girsh
  • Book: A Textbook of Clinical Embryology
  • Online publication: 05 March 2021
  • Chapter DOI: https://doi.org/10.1017/9781108881760.006
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  • Conception
  • Edited by Eliezer Girsh
  • Book: A Textbook of Clinical Embryology
  • Online publication: 05 March 2021
  • Chapter DOI: https://doi.org/10.1017/9781108881760.006
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Conception
  • Edited by Eliezer Girsh
  • Book: A Textbook of Clinical Embryology
  • Online publication: 05 March 2021
  • Chapter DOI: https://doi.org/10.1017/9781108881760.006
Available formats
×