Do prostaglandins (prostaglandins) play a role during the implantation period in a female patient of reproductive age with a history of gastrointestinal issues and abdominal pain who is trying to conceive?

Prostaglandins During Implantation

Yes, prostaglandins, particularly PGE2, are critically released during the implantation period and play essential roles in trophoblast adhesion to the decidua, chemokine expression for embryo apposition, and maintenance of luteal function necessary for successful implantation.

Role of Prostaglandins in Implantation

Prostaglandin E2 (PGE2) serves multiple critical functions during the implantation window:

• PGE2 induces chemokine expression that facilitates trophoblast apposition and adhesion to the decidua, which is essential for successful embryo implantation 1
• PGE2 maintains luteal function, which provides the progesterone support necessary for embryo development and early implantation 1
• The prostaglandin system operates through terminal synthases and specific receptors that regulate reproductive processes including fertilization and implantation 2

Clinical Implications for Women Trying to Conceive

Critical Medication Considerations

Women with gastrointestinal issues and abdominal pain who are trying to conceive should avoid or minimize non-steroidal anti-inflammatory drugs (NSAIDs), as these are prostaglandin synthesis inhibitors that can interfere with implantation 1:

• NSAIDs inhibit prostaglandin synthetase enzymes, blocking PGE2 production that is necessary for successful implantation 3
• Assessment of PGE2 protein and receptor expression levels should be considered in infertile women to optimize reproductive outcomes 1

Preconception Optimization

For women with inflammatory bowel disease and abdominal pain attempting conception:

• Clinical remission before conception is essential for improving pregnancy outcomes, and biologic agents should be continued throughout pregnancy rather than using NSAIDs for symptom control 4
• Preconception counseling by a multidisciplinary team should address medication management to avoid agents that interfere with prostaglandin-mediated implantation while controlling gastrointestinal symptoms 4
• Fecal calprotectin monitoring (cutoff 200 mg/mg) can assess IBD activity without relying on NSAIDs for symptom management during the preconception period 4

Prostaglandin Functions Throughout Early Reproduction

Beyond implantation, PGE2 contributes to multiple reproductive stages:

• PGE2 plays a pivotal role in ovulation by inducing meiotic maturation, cumulus expansion, and follicle rupture through ovulatory genes (Areg, Ereg, Has2, Tnfaip6) 1
• PGE2 enhances sperm function and binding capacity to oocytes by reducing extracellular matrix viscosity and decreasing phagocytic activity against sperm 1
• PGE2 and PGF2α work as opposing dyads in the female reproductive system, similar to how PGI2-TXA2 function in the vascular system 2

Common Pitfalls to Avoid

• Do not prescribe NSAIDs for abdominal pain management in women actively trying to conceive, as these inhibit the prostaglandin synthesis necessary for implantation 1, 3
• Do not assume that controlling gastrointestinal symptoms with prostaglandin inhibitors is safe during the periconception period, as this can interfere with multiple stages of reproduction 1
• Avoid stopping biologic therapy for IBD in favor of NSAIDs during pregnancy planning, as disease activity poses greater risks than continuing appropriate biologics 4