IVF周期中高雌、孕激素水平对着床期子宫整合素α vβ 3表达及子宫内膜容受性的影响

Effect of High Estradiol and Progesterone Levels on the Expression of Integrin α vβ 3 and Endometrial Receptivity in IVF Cycles

目的探讨IVF超促排卵过程中，超生理剂量的雌、孕激素对着床期整合素αVβ3表达的影响，从而推测IVF超促排卵所致的高雌、孕激素对子宫内膜容受性的影响．方法2012年5月至2013年10月于云南省第一人民医院生殖一科行IVF的33例因卵巢过度刺激综合征或过高孕酮水平取消新鲜周期胚胎移植的不孕症妇女为研究组，根据HCG日雌孕激素水平将研究对象分为3组：高E_2组（E_2≥5210pg／mL、P〈1．05ng／mL）；高P组（P≥1．05ng／mL,E_2〈5210pg／mL）；高E_2并高P组（P≥1．05ng／mL、E_2≥5210pg／mL），于取卵后7～8d用宫腔负压吸管（Pipelle管）取内膜组织．对照组为11例正常妇女，于超声监测排卵后7～8d同法取内膜，采用免疫组化SP法和组织学积分H-score法对整合素αVβ3在种植窗期子宫内膜中的表达进行定位和半定量分析，比较不同雌孕激素水平在着床期对整合素αVβ3表达的影响，从而推测IVF超促排卵中高雌、孕激素对子宫内膜容受性的影响．结果种植窗期高E_2组、高P组、高E_2并高P组患者与对照组比较整合素αVβ3的表达差异没有统计学意义（P〉0．05）．结论 仅仅依靠整合素αVβ3的表达来推测子宫内膜的容受性是不可靠的．

Objective To study the effect of high estradiol （E_2） and progesterone （P） levels on the expression of integrin αvβ3and analyze the relationship between serum estradiol/progesterone concentrations and endometrial receptivity within the implantation window in the controlled ovarian hyperstimulation cycles. Methods 33 infertile women cancelled embryo transfer due to OHSS or much high P level were assigned to three groups according to the concentrations of serum E_2 and P on the day of human chorionic gonadotrophin （HCG） administration： group 1 with high E_2 （E_2 ≥ 5210 pg/mL, P 〈 1.05 ng/mL）, group 2 with high P （P ≥ 1.05 ng/mL, E_2 〈 5210 pg/mL） , group 3 with high P accompanied with high E_2 （P t〉 1.05 ng/mL, E_2 ≥5210 pg/mL） . Endometrial biopsies were performed at 7-8 days after oocytes retrieval using Pipelle. 11 healthy fertile women served as control, and their endometrial biopsies were performed at 7～8 days after ovulation by daily transvaginal uhrasonographic evaluation. Endometrial integrin αvβ3 was detected by immunohistochemistry and semi-quantitatively analyzed by H-score. The relationship between serum P/E_2 concentrations and the expression of integrin αvβ3 within the implantation window was analyzed. Results No statistically difference in the expression of integrin αvβ3 was found between studied groups and control group. Conclusion Using integrin αvβ3 as the target is not a reliable way to evaluate the endometrial receptivity within the implantation window in the controlled ovarian hyperstimulation cycles.