The incidence of aberrant endometrial alphavbeta(3) vitronectin expression in a high risk infertility population: could prolonged GnRH agonist therapy play a role?
OBJECTIVE
Evaluate the incidence of aberrant endometrial integrin (alphavbeta(3) vitronectin) expression in patients at high risk for implantation defects.


METHODS
Retrospective case-control trial of 74 consecutive infertile patients with prior failed IVF cycles despite good embryo quality and/or endometriosis who underwent endometrial biopsy 9-11 days after an LH surge to assess the presence or absence of alphavbeta(3) vitronectin. Patients were separated into two groups for analysis based on the presence (Gr. A) or absence (Gr. B) of integrin expression. A subset of Gr. B patients (86.1%) was treated with a 2 month course of a GnRH agonist prior to IVF (Gr. B1). No Gr. A patients were so treated.


RESULTS
Absent alphavbeta(3) vitronectin expression was noted in 48.6% of patients evaluated. A trend towards more severe endometriosis was noted in Gr. B (57.1 vs 31.5%). Responses to controlled ovarian hyperstimulation and IVF cycle outcomes including ongoing pregnancy rates were similar between Gr. B1 patients untreated Gr. A controls (55.6 vs 63.9%).


CONCLUSIONS
A high incidence of absent endometrial alphavbeta(3) vitronectin expression is noted in patients at increased risk for implantation defects. Prolonged GnRH agonist therapy prior to an IVF cycle resulted in outcomes similar to untreated controls with positive expression.
Surrey
Eric S
ES
Colorado Center for Reproductive Medicine, Englewood, CO, USA. esurrey@colocrm.com
Minjarez
Debra A
DA
Schoolcraft
William B
WB
D000328:Adult; D016022:Case-Control Studies; D003613:Danazol / Q000008:administration & dosage / Q000627:therapeutic use; D004715:Endometriosis / Q000188:drug therapy / Q000378:metabolism; D004717:Endometrium / Q000378:metabolism*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000627:therapeutic use; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000378:metabolism*; D039302:Integrin alphaVbeta3 / Q000378:metabolism*; D016729:Leuprolide / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
D005300:Fertility Agents, Female; D039302:Integrin alphaVbeta3; D016729:Leuprolide; D003613:Danazol