Periodicity in the levels of serum plasminogen activator inhibitor-1 is a robust prognostic factor for embryo implantation and clinical pregnancy in ongoing IVF cycles.
BACKGROUND
Plasminogen activator inhibitor-1 (PAI-1) has been inversely correlated to proteolytic extracellular-matrix degradation exerted by urokinase-type (u-PA) and tissue-type plasminogen activators (t-PA). Any pathological disturbance in PAI-1 levels may lead to several pregnancy complications.


OBJECTIVE
To assess the influence of periodicity in serum PAI-1 levels on embryo implantation and clinical pregnancy outcome in IVF cycles.


METHODS
Prospective study of 120 IVF cycles at private infertility centre.


METHODS
Endometrial response (ER) assessment by measuring Endometrial thickness (cm) and echopattern (grade). Serum PAI-1(ng/ml) measurement by ELISA method on day of hCG, day of ET and days 7 and 14 of ET. Main outcome measure was clinical pregnancy.


METHODS
Student "t" test, ANOVA, Post-test for linear trend, Pearson Correlation.


RESULTS
PAI-1 levels declined from dhCG to dET (318.8 ± 36.1 to 176.1 ± 28.4) whereas they increased steadily from dET to d7 to d14ET (176.1 ± 28.4 to 285.2 ± 30.4 to 353.5 ± 150.4; P = 0.0004) in pregnant group (n = 31). Conversely, dhCG to dET levels increased in both nonpregnant (n = 75; 173.8 ± 18.3 to 280.8 ± 26.1) and biochemical pregnancy BCP (n = 14; 172.7 ± 31.1 to 216 ± 30.1) groups. The rising pattern from dET to d7 to d14ET was not observed in non-pregnant and BCP groups. ER thickness and grade shared significant correlation with serum PAI-1 on dET (Pearson r: ER = 0.28, Grade = 0.29) and d7ET (Pearson r: ER = 0.40, Grade = 0.23).


CONCLUSIONS
Periodicity in serum PAI-1 levels offers a robust prognostic factor for predicting clinical pregnancy outcome. The dhCG to dET PAI-1 transition is a decisive factor for either transferring embryos in same/ongoing cycle or cryopreserving them and postponing ET to subsequent natural cycle.
Department of Embryology/Biochemistry, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
Bindu N
BN
Mehta
Department of Biochemistry, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
Nirmalendu
N
Nath
Department of Endocrinology/Embryology, Vaunshdhara Clinic and Assisted Conception Centre, Nagpur, Maharashtra, India.
Natachandra
N
Chimote
IVF; Implantation; PAI-1; PA system; pregnancy outcome