Endometrial ezrin expression in women with tuboperitoneal factor infertility and repeated in vitro fertilization failures

Objective. To investigate endometrial morphological characteristics and ezrin expression in women with tuboperitoneal factor (TPF) infertility and repeated in vitro fertilization (IVF) failures. Subjects and methods. The investigation enrolled 60 patients aged 26 to 38 years with TPF infertility and a history of more than 2 repeated IVF failures (a study group) and 20 healthy fertile women of the same age with a history of healthy children (a control group). Endometrial pipelle biopsy was carried out during the implantation window (LH+7) and on days 8-9 of the cycle to rule out chronic endometritis. A semiquantitative method was used to estimate immunohistochemistry results in scores: O, no immunostaining (-); 0.5, less than 5% of the immunostained cells (±); 2, less than 20% (+); 4, 20 to 40% (++); and 6, more than 40% (+++). The investigation results were statistically processed using the analysis of variance ANOVA (for several groups) and Mann- Whitney test. Results. Analysis of the morphological structure of the endometrial indicated that its secretory transformation was seen during the implantation window in all the patients. At the same time, the study group was observed to have early, mid, and late secretory phases in 24 (40%), 27 (45%), and 9 (15%) patients, respectively; whereas in the control group there was a preponderance of a mid-secretory phase (80%; n = 16). The examination of mature endometrial pinopodia showed the preponderance of study group patients who had less than 20% of the mature pinopodia in the surface epithelium (45%). In the control group, mature pinopodia were 40% more common in the endometrial surface epithelium in the majority of the women. The highest erzin expression was detected in the endometrial pinopodia and epitheliocytes in the control group whereas it was lowest in the study group. Erzin accumulated in slightly lower amounts in the study group than in the control one. Conclusion. The infertile women showed the reduced accumulation of erzin in the pinopodia and cytoplasm of the endometrial epithelium, suggesting the possible occurrence of impairments in the adhesion of blastocysts, the generation and maturation of pinopodia, and the remodeling of cellular cytoskeleton, which made itself evident in abnormal receptivity of the endometrium and its abnormal implantation properties.

ezrin, endometrial receptivity, in vitro fertilization