{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T09:47:42Z","timestamp":1782812862226,"version":"3.54.5"},"reference-count":61,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"French Ministry of health","award":["PHRC 13-0039"],"award-info":[{"award-number":["PHRC 13-0039"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Background: The endometrial immune environment regulates maternal immune tolerance and plays a key role in embryo implantation. We investigated whether its impact on reproductive outcomes differs between fresh and frozen embryo transfer (FET) cycles. Methods: In this prespecified secondary analysis of a prospective randomized study, 493 good-prognosis IVF patients underwent endometrial immune profiling before embryo transfer. Patients with a balanced profile received standard care, whereas those with immune dysregulation were randomized to conventional or immune-guided precision care. Live birth rates (LBRs) were analyzed according to immune status, transfer type, and treatment strategy. Results: A transfer type-specific effect was observed. In FET cycles, a balanced immune profile was associated with higher LBR compared with immune dysregulation (52.4% vs. 14.7%; adjusted OR 5.32 [95% CI 1.53\u201320.92]; ARD +37.7%). Precision care improved LBR compared with conventional management (48.6% vs. 14.7%; OR 5.03 [1.66\u201317.63]; ARD +33.9%). No significant association between immune status and reproductive outcomes was observed in fresh transfers. Conclusions: The impact of the uterine immune environment differed according to embryo transfer type and was predominantly observed in FET cycles. These findings suggest that endometrial immune competence may be particularly relevant to implantation success after frozen embryo transfer and warrants confirmation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/cells15131186","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T08:26:15Z","timestamp":1782807975000},"page":"1186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differential Impact of the Endometrial Immune Environment in Fresh Versus Frozen Embryo Transfer"],"prefix":"10.3390","volume":"15","author":[{"given":"Nathalie","family":"L\u00e9d\u00e9e","sequence":"first","affiliation":[{"name":"Centre d\u2019Assistance M\u00e9dicale \u00e0 la Procr\u00e9ation, H\u00f4pital des Bluets, 4 Rue Lasson, 75012 Paris, France"},{"name":"MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Cr\u00e9teil, France"},{"name":"UFR Simone Veil Sant\u00e9, UVSQ, Universit\u00e9 Paris Saclay, 78180 Montigny le Bretonneux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada J.","family":"Habeichi","sequence":"additional","affiliation":[{"name":"MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Rahmati","sequence":"additional","affiliation":[{"name":"London Women\u2019s Clinic, London W1G 6AP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e9raldine","family":"Dray","sequence":"additional","affiliation":[{"name":"Centre d\u2019Assistance M\u00e9dicale \u00e0 la Procr\u00e9ation, H\u00f4pital des Bluets, 4 Rue Lasson, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kerkhoven","sequence":"additional","affiliation":[{"name":"MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6303-8557","authenticated-orcid":false,"given":"Eric","family":"Vicaut","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche Clinique, H\u00f4pital Fernand Widal, APHP, Universit\u00e9 Paris-Diderot Paris 7, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-4035","authenticated-orcid":false,"given":"Abdourahmane","family":"Diallo","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche Clinique, H\u00f4pital Fernand Widal, APHP, Universit\u00e9 Paris-Diderot Paris 7, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nino Guy","family":"Cassuto","sequence":"additional","affiliation":[{"name":"Laboratoire Drouot, 21 Rue Drouot, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Ruoso","sequence":"additional","affiliation":[{"name":"Laboratoire Drouot, 21 Rue Drouot, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Prat-Ellenberg","sequence":"additional","affiliation":[{"name":"Centre d\u2019Assistance M\u00e9dicale \u00e0 la Procr\u00e9ation, H\u00f4pital des Bluets, 4 Rue Lasson, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0112-983X","authenticated-orcid":false,"given":"Marie","family":"Petitbarat","sequence":"additional","affiliation":[{"name":"MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","first-page":"249","article-title":"WHO fact sheet on infertility gives hope to millions of infertile couples worldwide","volume":"12","author":"Ombelet","year":"2020","journal-title":"Facts Views Vis. 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