Elnaggar Ahmed, Farag Amr H, Gaber Mohamed E, Hafeez Mohamed Abdel, Ali Mohamed S, Atef Alaa M
Department of Obstetrics &Gynecology, Faculty of Medicine, Ain Shams University, Lotfy Elsayed Street, Abbasia, Cairo, Egypt.
Department of Obstetrics &Gynecology, Jersey General Hospital, The Parade, Jersey, UK.
BMC Womens Health. 2017 Sep 26;17(1):90. doi: 10.1186/s12905-017-0438-3.
Implantation defect is one of these contributing factors for unexplained infertility. In the mid-luteal phase, when implantation is expected to happen, Integrins expression is remarkably increased. So, Integrins could potentially serve as markers for the frame of the window of implantation. αVβ3 integrin could have a role as a potential receptor for embryonic attachment. The aim of the current study is to investigate whether the women with unexplained infertility have a pattern of expression of endometrial αvβ3 integrin that could differ from those who have normal fertility or not.
Two groups of women have been included in this study. The first group was the Unexplained Infertility Group. This group included women diagnosed with unexplained primary infertility. The second group was the fertile Group, which included fertile parous women presented to the family planning clinic seeking contraception. 2D transvaginal ultrasound scan (TVS) was performed six days after detecting urinary LH surge. (TVS) was used to measure endometrial thickness, and subendometrial blood flow color Doppler Resistance Index (RI). On the same day of transvaginal ultrasound, endometrial samples were taken using the Endocell® office suction sampler for Immunohistochemistry (IHC) study using monoclonal mouse IgG antibodies to detect endometrial αvβ3 integrin.
Thirty-five fertile women with a diagnosis of unexplained infertility were included as a group I [Unexplained infertility Group] along with an equal number of fertile women as group II [Fertile Group]. The group of women with a diagnosis of unexplained infertility had a significantly lower αvβ3 integrin score when compared to the fertile group (median score 0, range:0-2 and median score 1, range: 1-3 and for infertile and fertile groups respectively, P < 0.0001). In addition, the unexplained infertility group had significantly higher subendometrial flow RI and Significantly thinner endometrial thickness.
This study showed that Alpha v Beta 3 integrin is a significantly lower in endometrium in cases of unexplained infertility, which may suggest that underexpression of Alpha v Beta 3 integrin in human endometrium could be linked to defective uterine receptivity, and play a role as an unrecognized cause of infertility in this population of women. We need larger studies of adequate statistical power, ideally investigating more than one menstrual cycle in the same woman, to investigate the usefulness of using these molecular molecules in clinical practice.
着床缺陷是不明原因不孕症的影响因素之一。在黄体中期，预计会发生着床时，整合素表达显著增加。因此，整合素可能作为着床窗框架的标志物。αVβ3整合素可能作为胚胎附着的潜在受体。本研究的目的是调查不明原因不孕症女性的子宫内膜αvβ3整合素表达模式是否与正常生育女性不同。
本研究纳入两组女性。第一组是不明原因不孕症组。该组包括被诊断为不明原因原发性不孕症的女性。第二组是生育组，包括到计划生育门诊寻求避孕的已生育有生育能力的女性。在检测到尿促黄体生成素激增六天后进行经阴道二维超声扫描（TVS）。（TVS）用于测量子宫内膜厚度和子宫内膜下血流彩色多普勒阻力指数（RI）。在经阴道超声检查的同一天，使用Endocell®办公室抽吸采样器采集子宫内膜样本，用于免疫组织化学（IHC）研究，使用单克隆小鼠IgG抗体检测子宫内膜αvβ3整合素。
35名被诊断为不明原因不孕症的有生育能力女性作为第一组[不明原因不孕症组]，另有同等数量的有生育能力女性作为第二组[生育组]。与生育组相比，被诊断为不明原因不孕症的女性组αvβ3整合素评分显著更低（不孕组和生育组的中位数评分分别为0，范围：0 - 2和中位数评分1，范围：1 - 3，P < 0.0001）。此外，不明原因不孕症组的子宫内膜下血流RI显著更高，子宫内膜厚度显著更薄。
本研究表明，在不明原因不孕症病例中，子宫内膜中的αvβ3整合素显著更低，这可能表明人子宫内膜中αvβ3整合素表达不足可能与子宫容受性缺陷有关，并在这群女性中作为未被认识的不孕原因发挥作用。我们需要进行具有足够统计学效力的更大规模研究，理想情况下在同一女性中调查不止一个月经周期，以研究在临床实践中使用这些分子的实用性。
