Endometrial integrin expression in women with recurrent implantation failure after in vitro fertilization and its relationship to pregnancy outcome

Capsule:
There is no evidence of abnormal endometrial integrin expression in women with recurrent implantation failure. The expression of integrins a1, a4, and aVb3 have no prognostic value in subsequent IVF treatment.

Authors:
Carol Coughlan, M.R.C.O.G., Melanie Sinagra, Ph.D., William Ledger, Ph.D., T.C. Li, Ph.D., Susan Laird, Ph.D.

Volume 100, Issue 3, Pages 825-830.e2, September 2013

Abstract:

Objective:
To determine expression of integrins α1, α4, and αVβ3 in the glandular and luminal epithelium, stroma, and cells in the blood vessel walls of the endometrium from women with recurrent implantation failure (RIF) and to determine if they are of prognostic value in determining pregnancy outcome.

Design:
Prospective nonrandomized study.

Setting:
Department of reproductive medicine.

Patient(s):
Forty-five women with RIF and six healthy fertile women were recruited. RIF was defined as the failure to conceive after the transfer of four good-quality embryos in three or more fresh or frozen cycles.

Intervention(s):
Endometrial biopsy samples were obtained from women with RIF and control women on days LH+7–LH+9 of the cycle. Expression of integrins α1, α4, and αVβ3 was determined by immunohistochemistry.

Main Outcome Measure(s):
A semiquantitative measurement of expression of each integrin protein in the luminal and glandular epithelium, stroma, and cells in the blood vessel walls was determined by H-score analysis.

Result(s):
Expression of integrins α1 and α4 was greatest in the luminal and glandular epithelial cells and the cells in the blood vessel wall, and significantly higher expression of integrins α1 and α4 was seen in the glandular epithelium compared with the luminal epithelium (H-scores: α1 293 ± 15 and 180 ± 12, α4 287 ± 14 and 191 ± 11, respectively). Expression of αVβ3 in the epithelium and blood vessels was also greater than in the stroma but there was no significant difference in expression of αVβ3 in glandular and luminal epithelium. No significant difference in H-scores was seen for α1, α4, and αVβ3 expression in any of the endometrial compartments in tissue from women with RIF and control women. No significant difference in α1, α4, and αVβ3 expression in any compartment was observed between those who achieved a clinical pregnancy after subsequent assisted conception treatment (n = 21) and those who were unsuccessful (n = 24).

Conclusion(s):
RIF, when defined as failure to achieve a clinical pregnancy after the transfer of at least four good-quality embryos in three transfer cycles, is not associated with abnormal endometrial integrin expression. In addition, the expression of integrins α1, α4, and αVβ3 appears to have no prognostic value in subsequent IVF treatment.

  • Francisco Dominguez

    Although negative results are presented, why only 6 controls were used in the study compared to the much higher RIF patients?

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