Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
J Reprod Immunol. 2022 Sep;153:103678. doi: 10.1016/j.jri.2022.103678. Epub 2022 Jul 28.
Intrauterine infusion of human chorionic gonadotropin (hCG) is suggested to have the capacity to recruit regulatory T cells (Tregs) in the endometrium. However, the pregnancy outcome for infertile women with a lower level of Tregs after hCG intrauterine infusion remains unknown. By examining the expression of FoxP3 Tregs in the endometrium, this study aimed to evaluate the effectiveness of hCG intrauterine infusion in infertile women with lower endometrial Tregs in improving the Tregs level and the pregnancy outcome. This cohort study included 150 women aged 38 and younger with a lower FoxP3 Tregs level in the mid-luteal phase. Patients were divided into the control group (n = 73), and hCG group (n = 77). Patients in the hCG group received three times of hCG intrauterine infusion during the follicular phase in the next biopsy and the embryo transfer cycles. The results showed that the endometrial FoxP3 Tregs level increased significantly after hCG intrauterine infusion (P < 0.001). The effective rate in rescuing the endometrial Tregs level was 77.92% (60/77). The clinical pregnancy rate was increased significantly in the hCG group than the control group (54.8% vs. 74.0%, P = 0.014). The logistic regression result showed that hCG intrauterine infusion [adjusted odds ratio (aOR) (95% confidence interval (CI)) = 2.347 (1.119, 4.923), P = 0.024] and blastocyst transfer [aOR (CI) = 2.630 (1.090, 6.346)] are two independent factors contributing to the improved pregnancy outcome. These data highlighted the immune regulatory role of hCG intrauterine infusion and might facilitate the personal immunotherapy progress for unexplained infertility in patients with a lower endometrial Tregs level.
宫腔内注射人绒毛膜促性腺激素（hCG）被认为具有募集子宫内膜调节性 T 细胞（Tregs）的能力。然而，hCG 宫腔内注射后 Tregs 水平较低的不孕女性的妊娠结局仍不清楚。通过检测子宫内膜中 FoxP3 Tregs 的表达，本研究旨在评估 hCG 宫腔内注射对 Tregs 水平较低的不孕女性改善 Tregs 水平和妊娠结局的有效性。这项队列研究纳入了 150 名年龄在 38 岁及以下、黄体中期 FoxP3 Tregs 水平较低的女性。患者分为对照组（n=73）和 hCG 组（n=77）。hCG 组患者在下一次活检和胚胎移植周期的卵泡期接受三次宫腔内 hCG 注射。结果显示，hCG 宫腔内注射后子宫内膜 FoxP3 Tregs 水平显著升高（P<0.001）。挽救子宫内膜 Tregs 水平的有效率为 77.92%（60/77）。hCG 组的临床妊娠率显著高于对照组（54.8%比 74.0%，P=0.014）。logistic 回归结果显示，hCG 宫腔内注射[调整后的优势比（aOR）（95%置信区间（CI））=2.347（1.119，4.923），P=0.024]和囊胚移植[aOR（CI）=2.630（1.090，6.346）]是改善妊娠结局的两个独立因素。这些数据强调了 hCG 宫腔内注射的免疫调节作用，并可能促进 Tregs 水平较低的不明原因不孕患者的个体化免疫治疗进展。
