Local injury of the endometrium induces an inflammatory response that promotes successful implantation

Fertil Steril. 2010 Nov;94(6):2030-6. doi: 10.1016/j.fertnstert.2010.02.022. Epub 2010 Mar 24.


Objective: To study whether an injury-induced inflammation might be the mechanism underlying the favorable effect of endometrial biopsy on the implantation rate in in vitro fertilization (IVF) patients.

Design: Controlled clinical study.

Setting: A medical center IVF unit and a research institute.

Patient(s): Women undergoing IVF who had previous failed treatment cycles.

Intervention(s): Endometrial samples were collected from two groups of patients on day 21 of their spontaneous menstrual cycle. The experimental, but not the control group underwent prior biopsy treatment on days 8 or/and 11 to 13 of that same cycle.

Main outcome measure(s): Abundance of immune cells, cytokines/chemokines level, correlation between these parameters and pregnancy outcome.

Result(s): A statistically significantly higher amount of macrophages/dendritic cells (HLA-DR+ CD11c+ cells) and elevated proinflammatory cytokines, tumor necrosis factor-α (TNF-α), growth-regulated oncogene-α (GRO-α), interleukin-15 (IL-15), and macrophage inflammatory protein 1B (MIP-1B), were detected in day-21 endometrial samples of the experimental group. A direct stimulatory effect of TNF-α on MIP-1B, GRO-α, and IL-15 messenger RNA (mRNA) expression was demonstrated. A positive correlation was found between the levels of macrophages/dendritic cells, MIP-1B expression, and TNF-α expression and the pregnancy outcome.

Conclusion(s): A biopsy-induced inflammatory response may facilitate the preparation of the endometrium for implantation. Increased MIP-1B expression could possibly serve for prediction of implantation competence.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Embryo Implantation* / immunology
  • Endometrium / immunology
  • Endometrium / injuries*
  • Endometrium / pathology
  • Endometrium / surgery*
  • Female
  • Humans
  • Infertility, Female / immunology
  • Infertility, Female / pathology
  • Infertility, Female / surgery
  • Inflammation / immunology
  • Inflammation / pathology
  • Inflammation / physiopathology*
  • Inflammation Mediators / metabolism
  • Inflammation Mediators / physiology*
  • Interleukin-15 / metabolism
  • Macrophage Inflammatory Proteins / metabolism
  • Pregnancy
  • Tumor Necrosis Factor-alpha / metabolism
  • Young Adult


  • Inflammation Mediators
  • Interleukin-15
  • Macrophage Inflammatory Proteins
  • Tumor Necrosis Factor-alpha