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. 2024 Mar 4;21(1):22-27.
doi: 10.4274/tjod.galenos.2024.42959.

Evaluation of endometrial receptivity in recurrent pregnancy loss and recurrent implantation failure

Sultan Canan  1 , Mehmet Arda İnan  2 , Ahmet Erdem  3 , Erhan Demirdağ  3 , Mualla İlknur Gündüz  2 , Özlem Erdem  2 , Mehmet Erdem  3
Affiliations

Evaluation of endometrial receptivity in recurrent pregnancy loss and recurrent implantation failure

Sultan Canan et al. Turk J Obstet Gynecol. .

Abstract

Objective: The cause of implantation defects in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) has not been clearly established. We aimed to evaluate the immunohistochemical changes in HOXA-11, β1 integrin, focal adhesion kinase (FAK), cluster of differentiation 44 (CD44), and extracellular matrix protein 1 (ECM1) molecules during the receptive endometrial period in patients with RIF and RPL.

Materials and methods: This study was retrospectively conducted at a university hospital. After the exclusion of cases with pathology that may cause a change in the level of receptors in the endometrium, biopsies performed during the receptive period were selected, and the patients were categorized into RPL (n=15), RIF (n=16), control (n=16) groups. All preparations were immunohistochemically stained for HOXA-11, β1 integrin, FAK, CD44, and ECM1.

Results: HOXA-11 and β1 Integrin expression changes were similar between the RIF and control groups. However, FAK expression was significantly increased in the RIF group (p<0.01). Additionally, ECM1 and CD44 expressions were significantly decreased in the RIF group compared with the control group (p<0.01). There was no significant difference in the endometrial staining of HOXA-11, FAK, and ECM1 in patients with a history of RPL. However, β1 Integrin and CD44 levels were significantly decreased in the RPL group compared with the control group (p<0.05).

Conclusion: Implantation is a complex process, and altered adhesion mechanisms involved in endometrial receptivity may be related to defective implantation in patients with RIF and RPL. Among the adhesion molecules, the expression of CD44, β1 integrin, FAK, and ECM1 molecules varies in inappropriate implantation compared with the normal population.

Keywords: Adhesion molecules; endometrial receptivity; implantation; recurrent implantation failure; recurrent pregnancy loss.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Patient selection RIF: Recurrent implantation failure, RPL: Recurrent pregnancy loss
Figure 2
Figure 2
Endometrial staining in all groups When the pictures were examined in order, β1 Integrin had intense glandular staining in all groups. Although stromal staining was strong in the control and RIF groups, stromal staining was not observed in the RPL group. What is remarkable for FAK is the absence of glandular staining in the RIF group. CD44 did not show stromal staining in the RIF group; in the RPL group, neither stromal nor glandular staining was observed. The absence of glandular ECM1 staining was noted in the RIF group. RPL: Recurrent pregnancy loss, RIF: Recurrent implantation failure, FAK: Focal adhesion kinase, ECM1: Extracellular matrix protein 1 CD44: Cluster of differentiation 44
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