Mechanisms of implantation: strategies for successful pregnancy


Physiological and molecular processes initiated during implantation for pregnancy success are complex but highly organized. This review primarily highlights adverse ripple effects arising from defects during the peri-implantation period that perpetuate throughout pregnancy. These defects are reflected in aberrations in embryo spacing, decidualization, placentation and intrauterine embryonic growth, manifesting in preeclampsia, miscarriages and/or preterm birth. Understanding molecular signaling networks that coordinate strategies for successful implantation and decidualization may lead to approaches to improve the outcome of natural pregnancy and pregnancy conceived from in vitro fertilization.

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Figure 1: Signaling network for uterine receptivity and implantation.
Figure 2: Signaling networks in decidualization.
Figure 3: Potential adverse ripple effects during pregnancy arising from stage-specific defects in mice.
Figure 4: Plausible charting of adverse ripple effects in human pregnancy.

Change history

  • 08 January 2013

     In the version of this article initially published, the references included in Figure 3a were incorrect. The error has been corrected in the HTML and PDF versions of the article.


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We regret that space limitations precluded us from citing many relevant references. We thank K. Yoshinaga and A. Erlebacher for helpful discussions. Work embodied in this article from S.K.D.'s group was supported in part by US National Institutes of Health (NIH) grants (HD12304, HD068524 and DA06668), the March of Dimes, and the Grand Challenges Explorations Initiative through the Bill & Melinda Gates Foundation. J.C. is supported by an NIH National Research Service Award Fellowship (F30AG040858) and the University of Cincinnati Medical Scientist Training Program (T32 GM063483), and X.S. is supported by a Lalor Foundation Postdoctoral Fellowship.

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Correspondence to Sudhansu K Dey.

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Cha, J., Sun, X. & Dey, S. Mechanisms of implantation: strategies for successful pregnancy. Nat Med 18, 1754–1767 (2012).

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