Hydrosalpinges adversely affect markers of endometrial receptivity

While in-vitro fertilization (IVF) was initially developed in women withtubal factor infertility, recent clinical studies have suggested that thepresence of hydrosalpinges lowers implantation and pregnancy rates. Wepostulated that these hydrosalpinges cause impaired endometrialreceptivity. A total of 103 women with hydrosalpinges were prospectivelyevaluated, and compared with 55 infertile and 44 fertile controls. Allwomen had endometrial biopsies during the window of implantation, analysedby conventional histological criteria, and also stained for three integrinmarkers of endometrial receptivity (alpha1beta1, alpha4beta1 and alphavbeta3). Women with hydrosalpinges (cases) expressed significantly less ofthe alpha vbeta3 integrin compared with controls. There was no differencein expression of alpha1beta1 or alpha4beta1 among groups. A significantlygreater number of cases had out of phase histology and missing alpha vbeta3(type I defects) and absent integrin expression despite normal histologicalmaturation (type II) defects, compared with controls. Of 20 women withimpaired endometrial receptivity who were also biopsied after hydrosalpinxsurgery, 70% demonstrated increased alpha vbeta3 expression. Seventy-sevenpercent of type I and 57% of type II defects were correctedpostoperatively. Using markers of endometrial receptivity, this studydemonstrates that inflammatory hydrosalpinges have an adverse effect onendometrial receptivity, which in some cases may be overcome by surgicaltreatment of the hydrosalpinx.