Pharmacogenomics of Embryology and Endometrium in ART

Pharmacogenomics in ART does not end at ovarian stimulation. The lecture shifts focus to embryology, the endometrium, and the cases where classical protocols fail for reasons hidden in the genome — from oocyte donors to total fertilization failure after ICSI.

ESR1/ESR2 polymorphisms and endometrial receptivity

ESR1 and ESR2 polymorphisms in patients and oocyte donors correlate with embryo quality and cycle clinical efficacy. A particular clinical interest is genetic predictors of idiopathic thin endometrium, which open a new diagnostic class for patients previously catalogued as «cause unknown».

Calcium ionophore: indications and limitations

Systematically poor blastulation in younger patients is a distinct clinical problem. Calcium ionophore has a role as targeted therapy — in a selected cohort where artificial activation compensates for insufficient calcium signalling after fusion. It is not a «universal solution». The literature is mixed: some studies show benefit in specific indications, others show no effect in general populations. The speaker's own pilot data support efficacy when poor blastulation is combined with ESR polymorphisms.

WEE2 and total ICSI failure

The WEE2 gene encodes a kinase required for exit from meiotic arrest after sperm entry. WEE2 mutations are one of the identified causes of total fertilization failure after ICSI when all other parameters are normal. In such patients, repeat ICSI without intervention is futile — the diagnosis redirects them toward oocyte donation or experimental approaches.