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Within-Subject Between-Cycle Variability of Histological Dating, vß3 Integrin Expression, and Pinopod Formation in the Human Endometrium

Department of Pathology (J.O., A.C.); Institut Clinic of Gynaecology, Obstetrics and Neonatology (M.C., J.B.); Epidemiology and Biostatistics Unit (L.Q.); and Hormonal Laboratory (R.C.), Faculty of Medicine-University of Barcelona, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona 08036, Spain

Address all correspondence and requests for reprints to: Juan Balasch, M.D., Institut Clinic of Obstetrics and Gynaecology, Hospital Clínic, c/Casanova 143, 08036 Barcelona, Spain. E-mail: jbalasch{at}medicina.ub.es.

vß3 integrin expression and pinopod formation have been proposed as a means of distinguishing receptive endometrium from nonreceptive in clinical practice. However, one of the most intriguing facts in infertility is whether one cyclic event may be representative of all patients’ cycles, and no study has evaluated the cycle-to-cycle variability of the expression of any of these new proposed markers in human endometrium. We investigated histological dating, vß3 integrin expression, and pinopod formation in 45 endometrial biopsy specimens obtained in 15 primary infertility patients. All patients underwent three endometrial biopsies in consecutive spontaneous cycles, regardless of the previous histological findings. All endometrial samples were obtained on postovulatory d 7 as determined by ultrasonography. Agreement between the repeated observations (first vs. second, and first vs. third biopsies) with regard to histological dating and the presence or absence of vß3 integrin and pinopods in the endometrium was analyzed using the 2 x 2 frequency tables and Cohen’s coefficient. The values ranged from a low of -0.39 (level of agreement, poor) for vß3 integrin expression to a high of 0.32 (level of agreement, fair) for biopsy dating by anticipated window of implantation. Overall, these results demonstrate that all endometrial variables investigated had poor reproducibility and high variability cycle to cycle.

This work was supported in part by Grants 00/0399 and PI020036 from the Fondo de Investigaciones Sanitarias (to J.B.) and Grant RCMN (C03/08) from the Instituto de Salud Carlos III.

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