植入窗期血清孕激素水平及子宫内膜白血病抑制因子表达对体外受精-胚胎移植结局的预测价值

目的探讨植入窗期血清雌(E2)、孕(P)激素水平及子宫内膜白血病抑制因子(LIF)表达对体外受精-胚胎移植(IVF-ET)结局的影响。方法40例不育患者在行IVF-ET前一周期采用磁分离酶联免疫法测定植入窗期血清E2、P水平;免疫组化SP法和组织学积分H-score法对LIF在子宫内膜的表达定位和半定量分析。IVF-ET后患者分为:妊娠和未妊娠两组。结果植入窗期血清P水平妊娠及未妊娠组分别为(56.59±4.83)(、44.89±3.08)nmol/L,差异有统计学意义(P<0.05);LIF在子宫内膜腔上皮和腺体表达,两组分别为(1.56±0.41)、(1.31±0.32)及(1.45±0.31)、(1.15±0.37),差异有统计学意义(P<0.05)。血清P水平与子宫内膜LIF的表达显著相关(腺体r=0.589,P<0.01;腔上皮r=0.553,P<0.01)。结论植入窗期血清P水平下降及子宫内膜LIF的表达减弱可导致IVF-ET妊娠失败。植入窗期血清P水平和子宫内膜LIF的表达可作为预测IVF-ET成功与否的指标。

Examination of serum progesterone level and endometrial leukemia inhibitory factor during the implantation window and their relationship with in vitro fertilization and embryo transfer outcome

Objective: To determine the serum estradiol(E_2) and progesterone(P) levels and endometrial leukemia inhibitory factor(LIF) during the implantation window and their relationship with in vitro fertilization/embryo transfer(IVFET) outcomes.Methods: The endometrial samples and serum samples were obtained during the implantation window from 40 patients undergoing IVF-ET.The serum E_2 and P levels were measured by magneto-separate homogeneous enzyme immunoassay.The endometrial LIF was detected by immunohistochemistry using polyclonal antibody and semi-quantified by H-score.Forty patients were divided into two groups according to the clinical outcomes: the pregnancy group(16 patients) and non-pregnancy group(24 patients).Results: The serum P level during the implantation window was significantly higher in pregnancy group than that in the non-pregnancy group(56.59±4.83 nmol/L vs.44.89±3.08 nmol/L,P<0.05).The luminal epithelial and glandular scores of LIF immunostaining were significantly higher in pregnancy group than those in non-pregnancy group(1.56±0.41 vs.1.31±0.32,P<0.05) and(1.45±0.31 vs.1.15±0.37,P<0.05),respectively.The H-score of LIF in endometrial luminal epithelium and glandular epithelium was positively correlated with serum P level in two groups(glandular epithelium r=0.589,P<0.01;luminal epithelium r=0.553,P<0.01). Conclusion: The decreased serum progesterone level and the low expression of endometrial LIF during the implantation window can result in IVF-ET failure.The serum progesterone level and the expressions of endometrial LIF during the implantation window can be used to predict IVF-ET outcomes.