Does endometrial integrin expression in endometriosis patients predict enhanced in vitro fertilization cycle outcomes after prolonged GnRH agonist therapy?
OBJECTIVE
To determine whether endometrial expression of the integrin alpha(v)beta(3) vitronectin can predict which endometriosis patient subgroup will benefit from pre-IVF cycle prolonged GnRH agonist (GnRHa) therapy.


METHODS
Prospective randomized institutional review board approved pilot trial.


METHODS
Private assisted reproductive technology program.


METHODS
IVF candidates with regular menses, surgically confirmed endometriosis, and normal ovarian reserve.


METHODS
All patients underwent endometrial biopsy 9 to 11 days post-LH surge to evaluate alpha(v)beta(3) integrin expression. Patients were randomized either to receive depot leuprolide acetate 3.75 mg every 28 days for three doses before controlled ovarian hyperstimulation (COH) or to proceed directly to COH and IVF. Group 1: integrin-positive controls (N = 12); group 2: integrin-positive administered prolonged GnRHa (N = 8). Group A: integrin-negative controls (N = 7); group B: integrin-negative administered prolonged GnRHa (N = 9).


METHODS
COH responses, ongoing pregnancy and implantation rates.


RESULTS
There were no significant effects of GnRH agonist treatment in either of the integrin expression strata regarding ongoing pregnancy or implantation rates, although these outcomes were more frequent in group 2 vs. 1 (62.5% vs. 41.6% and 35% vs. 20.6%, respectively). This effect may have because of limited sample size. The value of a negative integrin biopsy in predicting an ongoing pregnancy after prolonged GnRH agonist therapy was only 44.4%.


CONCLUSIONS
Endometrial alpha(v)beta(3) integrin expression did not predict which endometriosis patients would benefit from prolonged GnRHa therapy before IVF.
Surrey
Eric S
ES
Colorado Center for Reproductive Medicine, 10290 Ridge Gate Circle, Lone Tree, CO 80124, USA. esurrey@colocrm.com
Lietz
Annette K
AK
Gustofson
Robert L
RL
Minjarez
Debra A
DA
Schoolcraft
William B
WB
D000328:Adult; D010064:Embryo Implantation / Q000502:physiology*; D004715:Endometriosis / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D039302:Integrin alphaVbeta3 / Q000235:genetics*; D054315:Oocyte Retrieval / Q000379:methods; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology; D010053:Ovary / Q000473:pathology / Q000601:surgery; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011897:Random Allocation; D014599:Uterus / Q000033:anatomy & histology
D039302:Integrin alphaVbeta3; D007987:Gonadotropin-Releasing Hormone