Manggiasih Dwiayu Larasati, et. all | Characteristics of Endometrial Cells............. Journal Educational of Nursing (JEN) Article history: Vol. 4 No. 1 – January – June 2021; page 9-19 Received: February 19, 21 p-ISSN : 2655-2418; e-ISSN : 2655-7630 Revised: February 25, 21 journal homepage: https://ejournal.akperrspadjakarta.ac.id Accepted: March 02, 21 DOI : 10.37430/jen.v4i1.82 Characteristics of Endometrial Cells and the Factors that Influence the Implantation Process Manggiasih Dwiayu Larasati1, Ita2 Department of Midwifery, RSPAD Gatot Soebroto College of Health Sciences, Jakarta-Indonesia Department of Nursing, RSPAD Gatot Soebroto College of Health Sciences, Jakarta-Indonesia E-mail: [email protected], [email protected] Abstract Infertility is a global health problem faced by 8 - 10% of couples in the world. It means 50 - 80 million couples have infertility problem. Knowledge about comprehensive and profound reproductive system is main asset for managing infertility. When look at various factors those contribute to women infertility, so the role of endometrium is very important. The optimal endometrial environment for receiving blastocyst is a major factor in the process of implantation and pregnancy. This study attempts to review and compare sources from research article, case report, and reviews from reputable international journals. Research by Germeyer et all (2010) shows that optimal growth and development of endometrium are factors those greatly contributes for successful implantation which is continued to pregnancy. The same thing is revealed by Neykova review (2020) which states the success implantation process is determined by the quality of the embryo, the readiness of the endometrium to accept the result of conception and interaction, and communication of molecular cells. Currently, various studies are being developed for evaluating endometrium condition through genetic improvement, the use of new biomarkers, non-invasive method even sophisticated method such as proteomic technique Endometrial Receptivity Assay (ERA) in order to solve women infertility problem. Keyword: Endometrium, Infertility, Implantation, Pregnancy. Introduction Secondary infertility is when a married Infertility is a source of complaints and couple who had previously had children anxiety for married couples. Infertility cannot have children again for two years affects about 50 - 80 million couples in the even though the couple is not using world [1]. In Indonesia there are contraceptives and is not breastfeeding [3]. approximately 12% of infertile couples [2]. The cause of infertility can come from Infertility is defined as the inability of a the husband or wife, or both. According to married couple to become pregnant for a statistics, 40% of infertility occurs in the period of six months to one year without female reproductive system, 40% occurs in using contraceptives and having active the male reproductive system, and 20% has intercourse [1]. no known cause [3]. Infertility in the female WHO Scientific Group classifies reproductive system can be caused by infertility into two types, namely primary several things, including menstrual infertility if a husband and wife have not abnormalities, abnormalities in the fallopian had children for two years even though the tubes, ovaries, and endometrial lining of the couple does not use contraceptives. uterus [1]. Journal Educational of Nursing (JEN) Vol. 4 No. 1 (2021) 9 Manggiasih Dwiayu Larasati, et. all | Characteristics of Endometrial Cells............. Various methods have been used to biomarkers, non-invasive methods and overcome the problem of infertility, one of even sophisticated methods such as the which is an engineering technique called in Endometrial Receptivity Assay (ERA) vitro fertilization (FIV). Fertilization proteomic technique in order to overcome technique which was performed in the infertility problems in women [6]. laboratory was successfully performed for Due to the close relationship between the first time in 1978. This success gave endometrial disorders and infertility, new hope to couples who have difficulty therefore, it is important to carry out in- having children [1]. However, in vitro depth studies and discussions about the fertilization techniques cannot guarantee nature or characteristics of endometrial 100% success for a couple to have cells and what factors influence their offspring. The success rate for this development during the implantation technique averages only about 35%. The process. failure of in vitro fertilization techniques is thought to be caused by failure of follicle Method formation, too low estradiol levels, and less This article is a literature review than ideal endometrial conditions [2]. compiled by discussing a number of The endometrium is an organ that plays research articles, case reports, review an important role in the process of articles obtained from reputable implantation and pregnancy. Research by international journals. There are around 389 Germeyer et all in 2010 showed that articles from a number of reputable journals impaired endometrial growth, such as a such as Elsevier, Lancet, Sciencedirect and decrease in the rate of cell proliferation, is a number of other publishers. Based on the one of the causes of failure in implantation inclusion criteria, 20 articles were reviewed and pregnancy [4]. In addition, several in this review. studies have shown that one of the causes of the low pregnancy rate in humans is an Result and Discussion overly thin endometrial lining [5]. The 1.Endometrium same thing was expressed by Neykova et al The endometrium is a thin layer found in 2020 which stated that the success of the in the inferior part of the uterus which is implantation process was determined by rich in tortuous blood vessels. The most the quality of the embryo, the readiness of important physiological function of the the endometrium to accept the results of endometrium is in the process of conception and molecular interactions and implantation as a result of fertilization. The communication between cells [6]. endometrium is important in the menstrual Based on the results of the study, cycle as a reproductive period. Most of the Cohen et all stated that patients with In endometrium is released during Vitro Fertilization who experienced menstruation, which then grows again in repeated implantation failure need to the proliferation phase followed by the consider endometrial histology during the sectoral phase [8]. Figure 1 shows these secretion phase [7]. In fact, various studies structural and functional changes in order are currently being developed to evaluate to prepare for blastocyst implantation and the condition of the endometrium through to support embryonic growth in early genetic improvement, the use of new pregnancy [6]. Journal Educational of Nursing (JEN) Vol. 4 No. 1 (2021) 10 Manggiasih Dwiayu Larasati, et. all | Characteristics of Endometrial Cells............. Figure 1. Implantation Process and Decidua Formation. The implantation process consists of surrounding the embryo turn into decidual apposition, adhesion or attachment, (D) cells. Immune cells such as invasion or penetration and decidualization macrophages and Uterine Natural Killer or formation of decidua. During apposition (uNK) cells play an important role during (A), blastocyst will express L-selectin the decidualization process, namely to while expression of Mucin-1 (MUC-1) form an environment conducive to will block blastocyst and prevent it from successful implantation. implanting. Furthermore, L-selectin will (http://smart.servier.com) [9] interact with its ligands which are The endometrium is composed of expressed mainly on pinopod during the stromal cells surrounded by a columnar implantation process. Early in the adhesion epithelial layer with glandular cells phase (B), the blastocyst initiates cleavage extending towards the stroma [10] (Figure of MUC-1 at the implantation site to 2). The lining of the endometrium can be ensure successful implantation. Cytokines, divided histologically and functionally such as Leukemia Inhibitory Factor (LIF), into three. The innermost or basal layer play an important role during the (stratum basale) is attached to the implantation process by supporting the myometrium. The middle layer is interaction between embryos and characterized by a spongy-looking stroma endometrial cells. During the invasion or called the stratum spongiosum. The penetration phase (C), trophoblast cells superficial layer is composed of a compact from the blastocyst penetrate the looking stroma called the stratum endometrial epithelium into the stroma. compactum. The middle layer is thicker Extra villiary trophoblast cells begin to than the superficial layer. The middle and multiply and differentiate into inner superficial layers are grouped into cytotrophoblasts and outer functional layers, because both layers syncytiotrophoblasts. After implantation show marked histological changes begins and the embryo penetrates the throughout the reproductive cycle [11]. luminal epithelium, the stromal cells Journal Educational of Nursing (JEN) Vol. 4 No. 1 (2021) 11 Manggiasih Dwiayu Larasati, et. all | Characteristics of Endometrial Cells............. Figure 2. Histological cross section of the endometrium [12] The lining of the endometrium is a layer (LH-surge) in the middle of the cycle that is responsive to changes in reproductive resulting in ovulation. The increased LH will hormones, so changes in this layer vary persist