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Norbert  Gleicher  

Center  for  Human  Reproduc5on   New  York,  NY,  USA   Declared  receipt  of  grant  support  from  various   pharmaceu5cal  and  medical  devices  companies  and  own   shares  in  Feritlity  Nutraceu5cals,  LLC;  receipt  of  patent   royal5es  from  the  company  and  to  own  CHR.  Otherwise   benefit  from  being  named  as  co-­‐inventor  on  a  number  of   patents.  


Intrauterine  therapies     Norbert  Gleicher    


Objec5ves   AJendees  will  acquire  the  following  skills:   •  Knowledge  about  the  importance  of  the   implanta5on  process  for  IVF  success   •  Knowledge  about  the  hypothe5cal  concept  of   enhancing  IVF  success  via  intrauterine  therapies   •  A  beJer  understanding  of  historical  efforts  at   intrauterine  therapies   •  Be  able  to  apply  intrauterine  therapies  to   improve  IVF  outcomes  


Intrauterine  therapies  are  nothing  new  


In  vitro  sperm  capacita5on  and   intrauterine  insemina5on    


Intrauterine  insemina5ons  

•  As  primary  goals   •  As  adjuvants  to  IVF  


Effects  of  IUDs  


The  endometrial  cavity  as  a   microenvironment   Influencing  the  microenvironment  


Improving  the  endometrial   microenvironment   •  Improving  IVF/implanta5on   •  Reducing  miscarriages  


Both  are  age-­‐dependent   Natural  pregnancy  rates  and  age  

Menkin  J,  Trussel  J,  Larsen  U.  Science.  1986;233:1389-­‐1394.  Reprinted   with  permission  from  AAAS.  

Source:  CDC  

Source:  CDC  


Follicle  development  from  primordial  to   preovulatory  status  

X  

OLD   NEW                                                                            Broekmans  FJ  et  al,  Endocrine  Reviews  2009  


FSH  and  androgen  receptors  

ReproducOve  Biology  and  Endocrinology  2011,  9:116  doi:10.1186/1477-­‐7827-­‐9-­‐116  


Endometrial  scratching?  

YES  


Endometrial  scratching?  

NO  


Endometrial  scratching?  


Endometrial  scratching?  


Autologous  endometrial  cell  therapy  

*  See  conflict  statement  


Autologous  endometrial  cell  therapy  


Autologous  endometrial  cell  traffic  


Granulocyte-­‐colony  s5mula5ng  factor   (G-­‐CSF)   •  In  oncology  as  proliferant   •  S.C.  for  RIF   •  S.C.  for  repeated  pregnancy  loss   •  Embryo  media  for  improved   implanta5on    


G-­‐CSF  and  thin  endometrium  


G-­‐CSF  and  thin  endometrium  


G-­‐CSF  in  rou5ne  IVF  


The  future   Does  endometri5s  impact  the  microenvironment?     Literature  inconclusive   Can  immune  modulators  affect  the  microenvironment?    


The  future   Trea5ng  endometrial  recep5vity  

Based  on  specifically   defined  defects  


The  future   Stem  cells  


Summary  


PRINCIPAL  COLLABORATORS:   CHR  SCIENTISTS:   David  H  Barad,  MD,  MS   Vitaly  A.  Kushnir,  MD   Ho-­‐Joon  Lee,  PhD   Yan-­‐Guang  Wu,  PhD   Emanuela  Lazzaroni,  MS   I-­‐Chen  Chen,  MS  

VISITING  CHR  SCIENTISTS:   Yao  Yu,  PhD   Andrea  Weghofer,  MD,  PhD,  MBA,  MS   Medical  University  Vienna  

Aritro  Sen,  PhD                                                          

Rochester  University  School  of  Medicine  &   Den5stry  &  CHR  

COLLABORATING  INSTITUTIONS:   Rochester  University  School  of  Medicine  &  Den5stry     Rockefeller  University  



L6 gleicher