MatriceLab’s research into reproductive immunology has shown that more than 80% of patients undergoing IVF treatment have endometrial immune dysregulation (Lédée et al, 2023). The impact of the immune environment on the success of embryo implantation has been demonstrated in multiple clinical trials (Genest et al, 2023). Endometrial Immune Profiling using the UTIMPRO test has been developed to better understand this phenomenon and define the individual immunological phenotype, which allows to adapt care to each patient.
The UTIMPRO test (PCT/EP2013/065355), based on an endometrial biopsy taken during an in-office consultation, is used to establish the individual endometrial immune profile, leading to a better understanding of implantation failures and recurrent miscarriages. By assessing the levels of different biomarkers in real-time PCR, one of three distinct immune profiles is defined: over-activation, under-activation or mixed activation.
Each of these immune profiles calls for a different therapeutic response. Identifying the profile enables us to propose appropriate treatments to optimize the success rate of the next implantation attempt.
Here are the 3 endometrial immune profiles you need to know about.
The under-activated immune profile
The local immune response required for embryo implantation is not initiated because the immune cells are not present or are immature. Insufficient immune cells result in insufficient nutrition for the embryo to develop.
As a result, the endometrium remains “non-sticky” and the embryo is unable to adhere to it, preventing further implantation.
Using the UTIMPRO test, therapeutic strategies to recruit and mature these immune cells are proposed, which are initiated to optimize the endometrium before the next embryo transfer.
The over-activated immune profile
In this phenotype, the immune response is excessive and the environment too aggressive for the embryo to implant permanently.
The embryo is recognized as foreign and rejected by over-activated immune cells, before being destroyed.
This also leads to an apoptotic process of programmed endometrial cell death.
A treatment to control local endometrial reactivity are needed to enhance local immune tolerance mechanisms.
The mixed uterine immune profile
This profile presents both :
- Immature uterine Natural Killer cells (as in an under-activated profile).
- excessive activation of these cells (as in an over-activated profile).
The aim of treatment will therefore be to control these two mechanisms:
Allowing uterine Natural Killer cells to mature, so that they can produce cytokines beneficial to implantation, and at the same time, controlling over-activation of these same cells.
This profile is often associated with the phenotype of immune over-activation.
From immune profiling to personalized treatment
By identifying these profiles, it is possible to diagnose immunological causes of repeated implantation failure that were previously unexplained. The next step is to implement the recommended treatments to correct the identified dysregulation, to be successful with the next embryo implantation attempt.
Once a personalized treatment has been implemented to correct the immune dysregulation identified by the UTIMPRO test, the endometrial response must be assessed to confirm the treatment efficacy.
The assessment of treatment efficacy works the same way as the initial analysis, using an endometrial biopsy obtained during consultation with the reproductive physician. To optimize IVF success with the personalized treatment based on the UTIMPRO test, the assessment of treatment efficacy is essential to confirm that the personalized treatment has corrected the immune dysregulation or if additional adaption is required.
Initial test versus assessment of treatment efficacy
When you perform the initial test, the results are valid for approximately 1 year. If a dysregulation of the endometrial immune profile is diagnosed, a personalized treatment plan is recommended to you by MatriceLab.
After personalized treatment is conducted, it is recommended to assess the outcome using a second test. This test can confirm that a balanced endometrium has been established before the next IVF cycle begins.
If you wish to perform another test after the one-year period, it is recommended to do this test without any immunomodulatory treatment, as the endometrial immune profile may have changed over this time.