Multifactorial Analysis Of Endometrial Inflammatory Lesions And Expression Of CD55 With Recurrent Implantation Failure And Recurrent Spontaneous Abortion

Objective:To make a comprehensive comparison and in-depth analysis of the results of hysteroscopy and endometrial histochemistry in patients with recurrent implantation failure and recurrent spontaneous abortion,to explore the impact of chronic inflammation and injury-associated endometrial lesions on assisted conception outcomes.Meanwhile,by analyzing the differential expression of complement regulatory protein CD55 in endometrium between patients with RIF and RSA and the control group,to explore the changes of endometrial microenvironment,and to provide new ideas for the diagnosis and treatment of RIF and RSA caused by endometrial inducement.Methods:The study was compartmentalized into the following two parts.1.The data of patients who underwent IVF/ICSI-ET in the Reproductive Medical Center of the Affiliated Hospital of Qingdao University from January 2020 to June 2022 were retrospectively analyzed,in which were divided into RIF(n=132),RSA(n=53)and normal controls(n=668)according to their diagnosis.Their hysteroscopy and endometrial biopsy histochemistry were statistically analyzed to find the impact of chronic inflammation and its concomitant associated endometrial lesions on assisted conception outcomes.2.A total of 25 infertile women who underwent IVF/ICSI-ET and hysteroscopy in the Reproductive Medical Center of the Affiliated Hospital of Qingdao University from June 2022 to August 2022 were selected.There were 10 cases of RIF,10 cases of RSA and5 cases of control group.The expression of CD55 in the endometrium of the three groups was determined by immunohistochemistry and optical density analysis,and to verify whether the complement regulatory protein CD55 was differentially expressed in the endometrium of RSA and RIF patients and normal women.Result:1.There was no statistically significant difference in BMI,basal FSH,basal LH,endometrial thickness on the day of transplantation and number of embryos transferred between the RIF and RSA groups compared with the control patients(P > 0.05);the mean age of the RIF and RSA groups was older relative to the control group(P < 0.001).2.The clinical pregnancy,miscarriage,and live birth rates among the three groups were statistically different(P < 0.05).The clinical pregnancy,miscarriage,and live birth rates in the RIF group were 9.9%,26.9%,and 7.2%,respectively;the clinical pregnancy,miscarriage,and live birth rates in the RSA group were 40.4%,72.0%,and 11.3%,respectively;and the clinical pregnancy,miscarriage,and live birth rates in the control group were 42.1%,20.5%,and 33.4%.3.Comparison of hysteroscopic and endometrial biopsy histochemical results among the three groups revealed that the incidence of inflammatory in the uterus was significantly higher in the RIF and RSA groups than in the control group,and the difference was statistically significant(P < 0.05).The incidence of CD38,CD138 double negative in RIF and RSA groups was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05);the incidence of CD38,CD138 double positive in RIF and RSA groups was higher relative to that in the control group,but the difference was not statistically significant(P > 0.05).4.A two-by-two comparison within groups revealed that the incidence of endometrial inflammatory lesions in the RIF group versus the control group was statistically significant(P < 0.05);the incidence of endometrial inflammatory lesions was higher in the RSA group compared with the control group,but the difference was not statistically significant(P > 0.05).5.Multiple logistic regression analysis revealed that age was a common risk factor for RIF and RSA,and the risk of disease increased by 20.9% and 10.4% for each 1-year increase in age,respectively;endometrial inflammatory lesions was a risk factor for RIF,and the risk of disease was 1.848 times higher in patients with this lesion than in those without it.6.The clinical pregnancy and live birth rates in patients with RIF and RSA in the presence of endometrial inflammatory lesions were 7.3%,5.3% and 36.5%,0.6%,respectively;after surgical and pharmacological treatment,the clinical pregnancy and live birth rates in patients with RIF and RSA were significantly higher,20.6%,16.7% and69.2%,30.8%,respectively.Through statistical analysis,there were significant differences in the number of clinical pregnancy and live birth between the two groups before and after treatment(P < 0.05).7.There were significant differences in CD55 expression in the endometrium of RIF and RSA versus normal women.CD55 expression in RIF,RSA,and control groups was0.0095±0.0038,0.0084±0.0016,and 0.0143±0.0020,respectively(P<0.05).Conclusion:1.Increased age is a common risk factor for patients with RIF and RSA,and endometrial inflammatory lesions is an independent risk factor for patients with RIF.2.Pre-treatment of endometrial inflammatory lesions before IVF/ICSI-ET in patients with RIF and RSA can significantly improve the clinical pregnancy rate and live birth rate of patients.3.Immunohistochemistry of endometrium from hysteroscopic biopsies revealed that CD55 expression in the endometrium of patients with RIF and RSA was significantly weaker than that of normal controls,suggesting that CD55 expression in the endometrium is associated with endometrial receptivity and maintenance of pregnancy,and that reduced CD55 expression may be one of the hallmark changes of impaired endometrial receptivity,which associated with traumatic changes in inflammatory endometrium.