子宫内膜异位症内膜组织中HOXA10基因异常DNA甲基化及意义

目的:检测子宫内膜异位症(EMs)在位及异位内膜HOXA10基因的表达及DNA的甲基化,探讨HOXA10基因异常表达及DNA异常甲基化在EMs发病及不孕机制中的状态和作用。方法:选择2009年1月至2010年8月在我院行腹腔镜手术治疗的卵巢子宫内膜异位囊肿患者20例(10例合并不孕)、非EMs患者20例(卵巢良性囊肿10例,输卵管因素不孕10例)。分别采取其在位、异位内膜及正常子宫内膜组织,采用荧光定量PCR方法检测HOXA10基因mRNA的表达,甲基化特异性聚合酶链反应(MSP)检测HOXA10基因3个启动子区F1、F2、F3的甲基化状态。结果:EMs在位和异位内膜组的HOXA10基因mRNA表达水平明显低于正常内膜(P<0.01),EMs在位内膜组总甲基化率45%(9/20),合并不孕患者甲基化率50%(5/10)。EMs异位内膜组总甲基化率40%(8/20),合并不孕患者甲基化率40%(4/10)。正常内膜组仅有1例卵巢成熟性畸胎瘤患者发生了甲基化,甲基化率5%(1/20)。EMs在位、异位内膜组总甲基化率及合并不孕患者甲基化率的差异无统计学意义(P=0.58,P=0.32),但与正常内膜组的差异均有显著统计学意义(P<0.01)。结论:HOXA10基因在EMs在位及异位内膜组织中均呈低表达状态,EMs中存在HOXA10基因DNA异常甲基化,EMs合并不孕患者内膜组织中HOXA10基因的DNA甲基化明显高于非EMs不孕患者。EMs中HOXA10基因的DNA异常甲基化可能与其发病及不孕机制有关,深入研究EMs中HOXA10基因DNA异常甲基化,有望为阻断EMs发病或治疗其引起的不孕提供新的思路。     

子宫内膜异位症与自然流产的相关性分析

目的:探讨子宫内膜异位症(EMs)与自然流产的相关性。方法:回顾性分析行IVF-ET妊娠的周期,其中EMs患者903个周期、单纯男性因素者643个周期及单纯输卵管因素者720个周期,比较分析基础FSH值、β-hCG检测阳性率(临床妊娠前)、稽留流产率和自然流产率(临床妊娠后)等指标。结果:基础FSH值EMs组高于男性因素组和输卵管因素组;平均年龄EMs组略大于输卵管因素组及男性因素组,平均不孕年限3组间无统计学差异;临床妊娠率EMs组(32.1%)与输卵管因素不孕组(33.6%)无统计学差异(P>0.05),但显著低于男性因素组(45.7%);稽留流产率、异位妊娠率妊娠率3组间无统计学差异(P>0.05);EMs组自然流产率(9.1%)高于男性因素不孕组(1.0%)和输卵管因素组(4.5%),差异显著(P<0.05)。结论:EMs患者自然流产率高于输卵管因素不孕及单纯男性因素不孕的患者。     

子宫内膜异位症生育指数对子宫内膜异位症合并不孕患者术后生育能力的评估

目的:探讨子宫内膜异位症(EMs)生育指数(EFI)对EMs合并不孕患者腹腔镜术后生育能力的评估作用。方法:回顾分析2005年1月至2010年7月在我院行腹腔镜手术治疗的296例EMs合并不孕患者的临床资料。按EMs EFI的评分标准计算EFI,计算不同分值患者的累积妊娠率。结果:296例患者术后3年的累积妊娠率为46.62%,患者EFI指数为8~10分、5~7分、≤4分的术后36个月的累积妊娠率分别为71.67%、42.86%和12.82%,不同分值间比较,差异显著(P0.05)。相同EFI评分的患者,术后时间越长妊娠率越低,差异显著(P0.01)。术后应用GnRH-a与不用GnRH-a治疗组比较,相同EFI评分患者的累积妊娠率均无显著差异(P0.05)。相同EFI评分患者的宫腔内人工授精妊娠率显著高于促排卵指导同房及期待自然妊娠者(χ2=0.0826,P0.05)。EFI评分≤4分与5~7分患者中,宫腔内人工授精自然周期组的妊娠率均显著低于促排卵周期组(χ2=0.0624,P0.05);8~10分患者中,两组的妊娠率则无显著差异(χ2=0.3488,P=0.5548)。结论:EFI评分可用于评估EMs合并不孕患者腹腔镜术后的生育能力,指导患者选择个体化的治疗方案。     

子宫内膜异位症不孕女性腹腔液菌群构成及TNF-α与IL-37水平研究

目的探讨子宫内膜异位症(endometriosis,EMs)不孕患者腹腔液中的微生物菌群及其肿瘤坏死因子α(TNF-α)和白介素37(IL-37)水平的变化。方法采集内膜异位症不孕组(T)29例和对照组(C)19例女性的腹腔液(peritoneal fluid,PF)标本,分别进行基因组DNA提取后Ion Torrent PGM平台测序检测微生物菌群和酶联免疫吸附试验(ELISA)检测IL-37及TNF-α水平。结果 EMs不孕患者和对照组女性PF中均发现了多种菌群存在,在菌门水平上主要分为变形菌门Proteobacteria、厚壁菌门Firmicutes、拟杆菌门Bacteriodetes、放线菌门Actinobacteria、梭杆菌门Fusobacteria,其中Proteobacteria为主要菌群,占60%以上的序列,软壁菌门Tenericutes只在对照组中检出1例,各菌门在两组间差异无统计学意义(P0.05)。EMs不孕妇女腹腔液中TNF-a和IL-37水平分别为(75.87±8.47)pg/ml、(372.03±68.02)pg/ml,高于对照组(57.76±8.29)pg/ml和(261.37±52.78)pg/ml(P0.05);EMs不孕组Ⅲ~Ⅳ期TNF-a的水平为(83.47±4.73)pg/ml,显著高于Ⅰ~Ⅱ期(74.29±8.26)pg/ml(P0.05),IL-37的水平在二者中差异无统计学意义(P0.05);内膜异位症不孕组中两者存在正相关关系(r=0.569,P0.001),对照组中两者不存在相关关系(r=-0.247,P=0.522)。结论 EMs不孕患者和对照组女性腹腔液中存在多种菌群,EMs不孕组中TNF-a和IL-37含量增高可能在EMs不孕症的发生机制中起到重要作用。     

萎缩性阴道炎患者的阴道菌群结构分析

目的揭示萎缩性阴道炎患者阴道群落特征,并探讨阴道菌群结构与萎缩性阴道炎发病之间的潜在关联。方法共纳入30名萎缩性阴道炎患者参与本研究(萎缩性阴道炎组),另有30名进行体检的绝经后健康妇女作为对照组。以16S r RNA基因为研究靶点,采用Illumina第二代高通量测序技术结合生物信息学分析,得阴道菌群结构数据。采用正则变量的逐步判别分析,对两组间群落组成的关联和差异进行比较。采用Spearman等级回归分析,探讨单个物种数量与疾病严重程度间的关系。结果在所有60例中,总共测得288个属的细菌。萎缩性阴道炎组和对照组间阴道菌群总体结构差异有统计学意义(P0.05)。其中12个属的主要细菌相对丰度差异显著。在绝经后正常妇女的阴道内,乳酸杆菌占据整个阴道微生物群落主导地位。萎缩性阴道炎组阴道加德纳菌相对丰度(41.7%)显著高于对照组(16.7%,P0.000 1),并取代乳酸杆菌成为阴道群落中生物优势最大的种群。萎缩性阴道炎组的乳酸杆菌失去了其生物优势地位,相对丰度(11.2%)显著低于对照组(53.2%,P0.000 1)。相关性分析显示,萎缩性阴道炎组患者生殖道症状的严重程度与乳酸杆菌的相对丰度呈显著负相关(r=-0.301,P0.001),而与加德纳菌(r=0.278,P0.001)及奇异菌属(r=0.166,P0.05)的数量呈显著正相关。结论阴道微生物群落失衡与萎缩性阴道炎发病存在关联。对于绝经后女性而言,处于生物优势地位的乳酸杆菌在维持阴道健康方面起到更为重要的作用。而阴道加德纳菌属和奇异菌属与绝经后妇女生殖道萎缩症状的严重程度有关,且这2种微生物的过度生长可能增加了罹患萎缩性阴道炎的风险。     

子宫内膜异位症患者阴道菌群特征性研究与功能预测

目的:探讨内异症患者阴道内特征性细菌群落,找出相关细菌种类,通过功能预测探索细菌与内异症患者交联的相关功能通路。方法:纳入受试者58例,每例患者分别于宫颈口和阴道后穹窿取样,最终诊断根据其手术记录和病理结果分类,其中内异症患者32例(55.17%),对照组患者26例(44.83%)。对采样标本进行PCR扩增,其中1例后穹窿标本扩增失败,共115例样本。使用一代Illumina测序对于细菌16s核糖体RNA(16s-rRNA)的高变区V3V4片段测序,原始数据经拼接、过滤后进行可视化操作并且挖掘细菌组学相关数据,使用KEGG作为参考数据库进行功能预测。结果:内异症患者与对照组的α多样性无显著差异,PCoA距离矩阵分析也并未见显著差异。内异症患者中,阴道奇异菌(Atopobium Vaginalis)和Howardella Ureilytica显著增多,短双歧杆菌(Bifidobaterium Breve)和阴道加德纳菌(Gardnerella Vaginalis)显著减少。功能预测方面,磷酸转移酶系统、乳果糖与甘露糖代谢、氨基糖与核苷酸糖代谢这三种功能在内异症患者中显著增加,而半胱氨酸与甲硫氨酸代谢、泛素体系在内异症患者中显著降低。结论:阴道炎相关细菌可能与内异症的发生发展有关,细菌差异的研究可能成为内异症无创诊治的新思路,功能预测为内异症发生发展机制的研究方向提供了参考借鉴。     

氧化应激对子宫内膜异位症患者体外受精-胚胎移植妊娠结局的影响

目的探讨氧化应激对子宫内膜异位症(EMs)患者体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法收集EMs合并不孕患者65例为EMs组,输卵管因素引起不孕患者165例作为对照组,分别比较两组患者一般资料、促排卵指标、实验室指标、外周血和卵泡液中氧化应激指标。结果 EMs组和对照组的促性腺激素Gn使用时间、基础卵泡刺激素(bFSH)、黄体生成素(LH)、抗苗勒管激素(AMH)比较,差异均无统计学意义(P0.05),而EMs组患者Gn使用量显著增加(P0.05)。EMs组患者的平均获卵数、受精率、优质胚胎率、可用胚胎率、临床妊娠率、流产率分别为(9.12±3.50)枚、(50.96±7.01)%、(20.71±2.21)%、(40.33±6.12)%、(40.98±5.34)%和(20.00±3.39)%,对照组分别为(18.54±3.92)枚、(70.83±8.23)%、(30.13±4.47)%、(56.64±7.87)%、(54.42±2.98)%和(7.14±2.86)%,两组比较,差异均有统计学意义(P0.05);EMs患者外周血中氧化物歧化酶(superoxide dismutase,SOD)及氧化应激指标活性氧(reactive oxygen species,ROS)表达量分别为(12.60±0.59)U/L和63.67±2.31,卵泡液中分别为(6.23±0.31)U/L和70.00±2.00,对照组外周血和卵泡液分别为(19.40±0.53)U/L、43.53±1.36、(10.2±0.60)U/L和50.33±1.53,与对照组比较,外周血和卵泡液中ROS显著升高,SOD显著降低(P0.01)。结论 EMs合并不孕患者ROS和SOD异常引起的氧化应激紊乱可能与其IVF-ET妊娠结局不良有关。     

超长方案降调节后LH添加时机对子宫内膜异位症患者IVF-ET的影响

目的:探讨在子宫内膜异位症(EMs)合并不孕患者体外受精-胚胎移植(IVF-ET)超促排卵过程中,经超长方案长效GnRH-a降调节后添加LH的合适时机。方法:回顾分析2010年1月至2012年4月在我中心行IVF-ET助孕的118例不孕合并EMs患者,共123个周期。所有周期均采用超长方案,根据添加LH时卵泡的直径分为3组:10～14mm(A组),14～16mm(B组)及≥16mm(C组),比较3组患者的卵巢反应性及IVF妊娠结局。结果:A组的P水平(0.72±0.63)显著低于B组(1.08±0.72)和C组(1.11±0.71)。A组的优质胚胎率和妊娠率分别为75.81%和55.00%,显著高于B、C组;A组获卵数(7.42±4.86)显著低于C组(11.34±5.71)(P<0.05)。结论:EMs合并不孕患者经超长方案长效GnRH-a降调节后,尽早添加外源性LH,可有效降低孕酮水平,提高优质胚胎率和妊娠率。     

HOXA10基因在子宫内膜异位症不孕患者内膜组织中的表达及意义

目的:探讨HOXA10基因在子宫内膜异位症(EMs)不孕中的作用及作用机制。方法:以行腹腔镜手术并经病理确诊为EMs合并不孕症的患者为研究对象(18例,A组),以同期行腹腔镜手术的输卵管性不孕患者(18例,B组)、正常生育组(15例,C组)为对照。分别应用荧光定量PCR、免疫组织化学和Western blotting等方法从mRNA及蛋白质水平检测HOXA10基因在EMs不孕症患者在位、异位子宫内膜以及对照组在位子宫内膜的表达。结果:HOXA10 mRNA及蛋白表达水平在C组的内膜较高;B组稍低于C组,但两者相比差异无统计学意义(P>0.05);A组的在位及异位内膜表达水平较C组明显降低(P<0.01);但A组的在位内膜与异位内膜基因和蛋白的表达水平均无统计学差异(P>0.05)。结论:HOXA10基因在EMs不孕患者在位子宫内膜中的表达显著降低,可能是EMs不孕患者子宫内膜容受性降低,进而引起不孕的重要因素之一。     

子宫内膜息肉的临床特征及息肉摘除术后对妊娠影响的相关因素分析

目的:探讨子宫内膜息肉(EPs)的临床特征,以及息肉摘除后对妊娠的影响及相关因素。方法:收集2014年5月至2015年5月于中山大学附属第一医院行宫腔镜手术或宫腹腔镜手术并最终病理确诊为EPs的患者464例,将其中单纯EPs合并不孕的123例患者做研究组。收集同期行相应手术的正常宫腔患者219例做为对照组。结果:464例EPs患者中,合并不孕占55.60%,合并月经异常占35.6%,合并子宫内膜异位症(EMs)占11.2%,合并子宫肌瘤者占8.4%。EPs摘除术后,研究组中30~35岁和≥35岁患者的临床妊娠率显著高于对照组(69.23%vs 49.30%,P=0.027;65.52%vs 40.54%,P=0.044),而两组中30岁患者的临床妊娠率比较,差异无统计学意义(64.29%vs 65.77%,P=0.864)。结论:EPs患者常合并不孕、月经异常、EMs或子宫肌瘤。EPs治疗后可改善年龄≥30岁患者的妊娠结局,既往有息肉史,年龄≥35岁或不孕年限≥10年是影响术后成功妊娠的因素。     

骨形态蛋白(BMP)-15对子宫内膜异位症患者IVF结局影响的临床研究

目的:探索卵丘颗粒细胞早期凋亡和骨形态蛋白-15(bone morphogenetic protein-15,BMP-15)对子宫内膜异位症(EMs)患者IVF结局的影响。方法:行体外受精-胚胎移植(IVF-ET)的不孕患者,根据不孕指征分为EMs组及对照组。分别记录患者一般情况、获卵数、正常受精卵数、卵裂数、优质胚胎数、胚胎种植数和临床妊娠率。流式细胞仪测定所有对象卵丘颗粒细胞的早期凋亡率,Western blotting检测卵泡液中BMP-15蛋白的表达量。结果:获卵率、受精率、卵裂率、优质胚胎率差异无统计学意义(P>0.05);EMs组与对照组相比,获卵数分别为8.2±5.7个和12.0±5.8个,着床率分别为29.73%和47.31%,临床妊娠率分别43.37%和69.32%,差异均有统计学意义(P<0.05)。EMs组卵丘颗粒细胞的早期凋亡率为37.82±15.81%,对照组为8.85±5.58%,差异具有统计学意义(P<0.01)。卵泡液中BMP-15蛋白相对表达量EMs组为0.67±0.18,对照组0.94±0.33,差异有统计学意义(P<0.05)。结论:EMs患者IVF着床率及临床妊娠率降低,可能与卵母细胞分泌较少的BMP-15、颗粒细胞早期凋亡率增加,影响卵母细胞质量和胚胎的正常发育有关。     

Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF

OBJECTIVE: To investigate the prevalence of bacterial vaginosis (BV) and abnormal bacterial vaginal flora in an infertile population and correlate with cervical cytokine production and in vitro fertilization (IVF) outcome. STUDY DESIGN: In a blinded study, 331 asymptomatic IVF patients were evaluated for BV, abnormal vaginal flora and cervical cytokine production (interleukin 1 beta [IL-1 beta] and IL-8) on the day of oocyte retrieval. All patients received tetracycline prophylaxis at the time of oocyte retrieval. RESULTS: BV was identified in 4.2% (14/331) of the patients. Patients with idiopathic infertility were more likely to have BV than were women with other causes of infertility (P = .02 vs. male factor, P = .03 vs. tubal factor and P < .01 vs. endometriosis-associated infertility). Patients with abnormal vaginal flora had higher cervical IL-1 beta and IL-8 cytokine levels as compared to patients with normal vaginal flora. IL-1 beta and IL-8 levels in the study subjects correlated highly. No differences were detected in IVF outcome parameters based on the vaginal flora determined at the time of retrieval. CONCLUSION: Abnormal vaginal flora, including that causing BV, is associated with elevated cervical levels of IL-1 beta and IL-8. The induction of proinflammatory cytokines by an altered vaginal ecosystem may be a previously unrecognized cause of idiopathic infertility.     

Th1/Th2细胞因子在不同临床特征的EMs患者差异性表达

目的:研究Th1、Th2各细胞因子在不同临床特征的子宫内膜异位症(EMs)患者差异性表达。方法:收集120例拟诊为"EMs"的患者临床资料。患者均于卵泡期行腹腔镜手术探查,术后经病理证实EMs者87例,非EMs者33例,将EMs组和非EMs组患者分别以主要主诉及临床特征如不孕、痛经/慢性盆腔痛、月经异常、卵巢受累进行再分组,应用ELISA法检测患者腹腔液中IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ的表达。结果:以"痛经/盆腔痛"为主要临床特征的EMs组与非EMs组患者腹腔液TNF-α表达有显著差异,显示其与EMs盆腔痛有相关性(P=0.00);以"不孕"为主要临床特征的EMs组与非EMs组患者腹腔液IL-2表达有统计学差异(P=0.03);在检查有盆腔包块或月经异常的患者,术中探查卵巢子宫内膜异位囊肿或明确卵巢受累者的腹腔液IL-10在EMs组与非EMs组表达有统计学差异(P=0.01)。结论:在EMs患者Th1/Th2漂移的免疫异常中,不同的细胞因子在发病和临床特征的形成中发挥作用。     

宫腹腔镜术后联合GnRH—a治疗轻中度内异症性不孕的疗效分析

目的：探讨宫腹腔镜术后联合不同药物对轻、中度子宫内膜异位症（EMs）性不孕患者妊娠率的影响。方法：回顾分析2008年9月至2011年12月在我院就诊的82例Ⅱ～Ⅲ期EMs性不孕患者的临床资料，患者均行宫腹腔镜联合保留生育功能的手术。按照严格的纳入和剔除标准，筛选出有自然受孕能力的患者，术后按个人意愿用药。按患者术后用药情况分为对照组（18例）、促性腺激素释放激素激动剂组（GnRH．a，博恩诺康）（31例）和口服避孕药组（去氧孕烯炔雌醇片，妈富隆）（33例），比较3组患者在术后不同时期的妊娠率及异位妊娠的发生率。结果：博恩诺康组、妈富隆组和对照组患者术后1年内的妊娠率分别为77．42％（24／31）、51．52％（17／33）和33．33％（6／18），博恩诺康组显著高于对照组及妈富隆组（P〈0．05），而后两组则无显著差异（P〉0．05）。3组患者的异位妊娠率分别为3．23％（1／31）、6．06％（2／33）和5．56％（1／18），均无显著差异（P均〉0．05）。术后1年内，Ⅱ期EMs患者中，3组妊娠率差异显著（P=0．020）；Ⅲ期EMs患者中，3组妊娠率无显著差异（P=0．297）。II、HI期患者中，3组的异位妊娠率均无显著差异（P〉0．05）。结论：宫腹腔镜术后联合博恩诺康有利于改善轻、中度EMs性不孕患者的生育能力。     

Acrosin activity as a potential marker for sperm membrane characteristics in unexplained male infertility

OBJECTIVE: To evaluate sperm membrane system integrity in unexplained infertile male subjects with three consecutive conception failures on IUI even though semen clinical parameters were normal. DESIGN: Prospective study. SETTING: Medical biotechnology laboratory, School of Medical Science and Technology IIT Kharagpur, India. PATIENT(S): Twenty-nine patients with unexplained infertility, 17 normal proven-fertile healthy donors, and 21 infertile males with low motility but with other semen parameters remaining normal. INTERVENTION(S): Semen samples were collected from unexplained infertile patients as well as from healthy fertile donors after abstinence of 3-5 days and were analyzed according to World Health Organization guidelines. MAIN OUTCOME MEASURE(S): Release of 5'-nucleotidase (plasma membrane marker), lactate dehydrogenase (mitochondrial marker) and free acrosin, proacrosin, and total acrosin (acrosomal membrane marker). RESULT(S): Plasma membrane integrity and respiratory activity of sperm cells were comparable in all three groups. The proacrosin-acrosin system was adversely affected in unexplained infertile subjects despite high sperm motility. CONCLUSION(S): Total acrosin activity may be considered as a sensitive biochemical marker for clinical evaluation of unexplained infertility in males.     

Relationship between expansion of the CAG repeat in exon 1 of the androgen receptor gene and idiopathic male infertility

OBJECTIVE: To determine whether expansion of CAG repeats in exon 1 of the androgen receptor is correlated with impaired spermatogenesis in patients with male idiopathic infertility. DESIGN: A retrospective study. SETTING: Medical school in Besan?on, France. PARTICIPANT(S): Thirty-seven infertile patients with azoospermia or oligospermia and 50 fertile controls. INTERVENTION(S): History, physical, hormonal assays, semen analysis, and collection of blood samples in order to study the androgen receptor's gene. MAIN OUTCOME MEASURE(S): Blood samples were collected from each infertile patient and control. The length of the CAG repeat segment was evaluated by using polymerase chain reaction (PCR) electrophoresis in exon 1 and PCR single-strand conformation polymorphism in exons 2-8. RESULT(S): The mean length of the CAG repeats was significantly different between infertile and fertile patients (23.91 +/- 0.5 vs. 22.20 +/- 0.4). No mutation was detected in exons 2-8 of the androgen receptor gene in infertile patients. CONCLUSION(S): Expansion of the CAG repeat segment of the androgen receptor is correlated with male idiopathic infertility. The number of CAG repeats may therefore have a modulatory effect on normal androgen receptor function.     

Presence of Chlamydia, Mycoplasma, ureaplasma, and other bacteria in the upper and lower genital tracts of fertile and infertile populations

Objective: The genital mycoplasmas (Mycoplasma hominis and Ureaplasma urealyticum) and Chlamydia trachomatis have been implicated as possible etiologic factors in infertility. Their role in patients with infertility needs to be further defined.Methods: Seventy-nine infertile patients underwent laparoscopy with cultures obtained for aerobic and anaerobic bacteria, Chlamydia, Mycoplasma, and Ureaplasma from the peritoneal fluid, fallopian tube, endometrium, and endocervix. Cultures for similar organisms were taken from the endocervix of 80 fertile women in their first trimester. Culture results were also compared according to ovulatory status and laparoscopic findings in the infertile group.Results: There were no differences in the recovery of Ureaplasma (29% vs. 28%) or Chlamydia (4% vs. 0%) positive cervical cultures in the fertile and infertile groups, respectively. However, a significantly higher number of Mycoplasma positive cervical cultures (14% vs. 5%, P = 0.05) were found in the fertile group. Only two upper genital tract cultures were found to be positive (Ureaplasma).Conclusions: Therefore, if these organisms play a role in infertility, they are present and eradicated prior to infertility work-up and thus do not supports the use of a routine trial of antibiotics prior to laparoscopy.     

Leptin is not involved in the pathophysiology of endometriosis-related infertility

OBJECTIVE: Changes in peritoneal fluid (PF) composition may affect fertilization as well as early embryonic development. Leptin, an adipocyte hormone, has been shown to act as a link between adipose tissue and the reproductive system. Therefore, we decided to assess peritoneal and serum leptin levels in infertile endometriotic patients. PATIENTS: Seventy-two women were studied, including 30 fertile and 18 infertile women with ovarian endometriotic cysts and, as a reference group, 24 patients with unexplained infertility. RESULTS: No significant difference in the peritoneal and leptin levels was found between the studied groups. Significantly higher PF leptin concentration was observed in patients with stages III and IV of endometriosis as compared to those with minimal stage of the disease. In fertile patients with endometriosis a positive correlation has been found between PF and serum leptin concentrations. CONCLUSIONS: No differences in peritoneal or serum leptin levels between infertile and fertile women with endometriosis suggest that this cytokine is not involved in pathophysiology of endometriosis-related infertility.     

Difference in alpha(v)beta3 integrin expression in endometrial stromal cell in subgroups of women with unexplained infertility

OBJECTIVE: The aim of the study was to evaluate the endometrial receptivity by using alpha(v)beta3 expression in the midsecretory phase in different endometrial compartments in women with unexplained infertility. STUDY DESIGN: A prospective controlled clinical trial in a setting of a university teaching hospital was performed. Thirty-three fertile and 33 infertile women were included in the study. Midluteal endometrial biopsies of the endometrium were carried out during the implantation window. Immunohistochemical staining was performed for the expression of alpha(v)beta3 in endometrial samples. Alpha(v)beta3 expression was measured using the HSCORE scoring system in the endometrial glandular and luminal epithelium and in the endometrial stroma. Serum levels of estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, total testosterone and dehydroepiandrosterone sulphate were measured in the early follicular phase and in the midluteal phase. RESULTS: The average alpha(v)beta3 integrin expression at different sites of the endometrium was not different in the infertile and fertile controls. However, the stromal alpha(v)beta3 integrin was found to be expressed significantly less in a subgroup of women with lower than average alpha(v)beta3 integrin expression in luminal epithelium than in fertile controls and significantly more in a subgroup of women with higher than average alpha(v)beta3 integrin expression in luminal epithelium. There was no difference in stromal alpha(v)beta3 integrin expression in the lower or higher glandular alpha(v)beta3 integrin expression subgroups. CONCLUSIONS: Alpha(v)beta3 integrin expression in endometrial stromal cells may be different in subgroups of women with unexplained infertility.