PhD Defense: Endometrium-related infertility; molecular and clinical insights

Infertility, defined as the inability to achieve a pregnancy after 12 months of regular, unprotected intercourse, affects an estimated 186 million couples worldwide, presenting significant physical, emotional, and financial challenges. The causes are often complex and multifactorial. In 50% of couples, no clear cause is found, leading to a diagnosis of unexplained infertility. A successful pregnancy begins with the implantation of a viable embryo into a receptive endometrium. Disruptions in endometrial function can be potential causes of unexplained infertility.

In her thesis, Bich Bui investigated the endometrium of infertile and fertile women at the molecular level. She analyzed the genetic profile (transcriptome) and the presence of microorganisms (microbiota) in the endometrium and developed mini-organs (organoids) of the endometrium. Her findings reveal molecular differences between the endometrium of infertile and fertile women. However, these differences are not consistent with the findings of other studies in this research field, due to varying study designs. Consequently, it remains unclear whether endometrial dysfunction plays a role in unexplained infertility. Bui therefore proposes to characterize the endometrium at the single-cell level to identify consistent molecular patterns, which could enhance the understanding of endometrium-related infertility and improve diagnosis and treatment. Large collaborations and standardized protocols are necessary for this to be successful.

Additionally, she investigated the effectiveness of endometrial scratching, a procedure in which a biopsy of the endometrium is taken to increase the chances of pregnancy in couples with unexplained infertility. In couples who did not conceive after a first IVF/ICSI cycle, endometrial scratching was found to improve the chances of pregnancy. However, there is currently insufficient evidence to confirm the effectiveness of this procedure in couples with unexplained infertility who are trying to conceive spontaneously for a period of 6-12 months.