BackgroundImplantation defect is one of these contributing factors for unexplained infertility. In the mid-luteal phase, when implantation is expected to happen, Integrins expression is remarkably increased. So, Integrins could potentially serve as markers for the frame of the window of implantation. αVβ3 integrin could have a role as a potential receptor for embryonic attachment. The aim of the current study is to investigate whether the women with unexplained infertility have a pattern of expression of endometrial αvβ3 integrin that could differ from those who have normal fertility or not.MethodTwo groups of women have been included in this study. The first group was the Unexplained Infertility Group. This group included women diagnosed with unexplained primary infertility. The second group was the fertile Group, which included fertile parous women presented to the family planning clinic seeking contraception. 2D transvaginal ultrasound scan (TVS) was performed six days after detecting urinary LH surge. (TVS) was used to measure endometrial thickness, and subendometrial blood flow color Doppler Resistance Index (RI). On the same day of transvaginal ultrasound, endometrial samples were taken using the Endocell® office suction sampler for Immunohistochemistry (IHC) study using monoclonal mouse IgG antibodies to detect endometrial αvβ3 integrin.ResultsThirty-five fertile women with a diagnosis of unexplained infertility were included as a group I [Unexplained infertility Group] along with an equal number of fertile women as group II [Fertile Group]. The group of women with a diagnosis of unexplained infertility had a significantly lower αvβ3 integrin score when compared to the fertile group (median score 0, range:0–2 and median score 1, range: 1–3 and for infertile and fertile groups respectively, P < 0.0001). In addition, the unexplained infertility group had significantly higher subendometrial flow RI and Significantly thinner endometrial thickness.ConclusionThis study showed that Alpha v Beta 3 integrin is a significantly lower in endometrium in cases of unexplained infertility, which may suggest that underexpression of Alpha v Beta 3 integrin in human endometrium could be linked to defective uterine receptivity, and play a role as an unrecognized cause of infertility in this population of women. We need larger studies of adequate statistical power, ideally investigating more than one menstrual cycle in the same woman, to investigate the usefulness of using these molecular molecules in clinical practice.

No abstract

Aim: To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction of subsequent occurrence of preterm birth (PTB). Methods: Eligible women who presented at 24-34 weeks of gestation with threatened PTL had their cervicovaginal secretions sequentially sampled for fetal fibronectin (fFN) using two types of swabbing techniques. The first swab was a blind vaginal swab collected without the aid of speculum, while the second one was a routine cervicovaginal swab. All participants were followed up until delivery. Results: fFN in both swabs was significantly higher in women who delivered before term compared with women who delivered at term. On regression analysis, r 2 = 0.735 and 0.785 for blind vaginal and cervicovaginal swabs respectively, while on receiver operating characteristic analysis the area under curve was 0.965 and 0.977, respectively, without a statistically significant difference. Using an fFN cut-off of ≥0.05 μg/dL, the sensitivity, specificity, positive predictive value and negative predictive value of blind vaginal swab to predict PTB were 53.9%, 91.9%, 70.0% and 85.0%, respectively; while those for cervicovaginal swab were 58.3%, 94.7%, 77.8% and 87.8%, respectively. Conclusions: In women presenting at 24-34 weeks of gestation with threatened PTL, blind vaginal fFN swab is as effective as cervicovaginal swab to predict PTB, but it is easier to perform and does not require doctor supervision.

Objectives: To compare GnRH agonist to hCG for triggering ovulation in polycystic ovarian syndrome treated with clomiphene citrate. Study design: Prospective randomized study. Materials & methods: Eighty five infertile women with PCOS participated in a randomized allocation concealed prospective trial and had induction of ovulation with clomiphene citrate. GnRH agonist 0.2 mg subcutaneously (group 1) or hCG 10,000 IU intramuscularly (group 2) was given to trigger ovulation. Primary outcome was mid-luteal serum progesterone, while secondary outcomes were ovulation rates and clinical pregnancy rates along 3 cycles. Results: No difference was found between group 1 and group 2 regarding mean serum progesterone and clinical pregnancy rates in each cycle. Cumulative pregnancy rates were similar (17.14% versus 20% respectively; P = 0.332). Ovulation rates were 80% versus 68.6% (P = 0.413); 94.3% versus 90.9% (P = 0.669); 97.1% versus 93.7% (P = 0.603) in the two groups respectively. However, a significant rise in number of patients with mid-luteal serum progesterone >10 ng/mL was noted in the 3rd cycle between both groups, (P < 0.0001 for group 1 while P = 0.007 for group 2). Conclusion: Triggering ovulation with GnRH-a after treatment with clomiphene citrate in PCOS, in view of its known protective effect against OHSS, may be an effective physiological alternative