Abstract
Objective To assess uterine receptivity in women with unexplained infertility using integrin cell adhesion molecules as markers.
Design Prospective, controlled study design.
Patients Eighty-seven nulliparous women with unexplained infertility and 32 fertile and infertile parous controls.
Main Outcome Measure Immunohistochemical staining for alpha 1, alpha 4, and beta 3 integrin subunits in endometrial biopsies obtained during the window of implantation (days 20 to 24), using the semiquantitative HSCORE by two observers in a blinded fashion.
Results All endometrial biopsies from parous controls contained positive immunostaining for the alpha 1, and beta 3 integrin subunits in glandular epithelium. Some samples from parous controls were missing the alpha 4 subunit. In contrast, compared with parous controls, biopsies from women with unexplained infertility had reduced significantly beta 3 expression, with similar expression of alpha 1 and alpha 4. Two distinct defects in integrin expression were identified: "out-of-phase" samples that lacked beta 3 because of histologic lag (type I defects) and "in-phase" endometrium that still failed to express this integrin (type II defects). These subclassifications accounted for 26% and 39% of the total unexplained infertility group, respectively.
Conclusions Abnormal endometrial integrin expression was a frequent finding in women with unexplained infertility. These data suggest that defective uterine receptivity may be an unrecognized cause of infertility in this population of women.
integrin markers uterine receptivity unexplained infertility, beta 3 integrin expression endometrial biopsy implantation, endometrial integrin deficiency unexplained infertility women, Lessey integrin uterine receptivity implantation window, alpha 1 alpha 4 beta 3 integrin endometrium, defective uterine receptivity implantation window markers, endometrial biopsy immunohistochemistry integrin expression, out of phase endometrium histologic lag implantation failure, cell adhesion molecules endometrial receptivity infertility, window of implantation days 20 to 24 integrin staining
Keywords
Adult, Biomarkers/analysis, Biopsy, Endometrium/cytology/pathology, Female, Fertility, Humans, Immunoenzyme Techniques, Immunohistochemistry, Infertility, Female/pathology, Integrin Alpha1, Integrin Alpha4, Integrin Beta3, Integrins/analysis, Observer Variation, Prospective Studies, Reference Values, Single-Blind Method, Uterus/physiology/physiopathology, Biomarkers, Integrin Alpha1, Integrin Beta3, Integrins, Integrin Alpha4