The effect of chronic endometritis and the level of endometrial Integrin alphaV/beta3, Prokineticin-1, Estrogen receptor (ER), Progesterone receptor expressions on reproductive prognosis in infertile women with chronic endometritis

Background: Chronic endometritis is a chronic edematous inflammatory disease of the endometrium, which causes a decrease in fecundity and fecundability in the reproductive period, and improves reproductive prognosis when treated. Prokineticin-1 (PK1) with the other name Endocrine Gland-Derived Vascular Endothelial Growth Factor (EG -VEGF) is a reproductive tissue-specific angiogenesis factor released from endocrine glands. It is in charge of regulating and modulating endothelial structure, structure and functioning, where it is established that it is stimulated by reproductive hormone in in-vitro studies. Integrin proteins are known to be involved in implantation and Integrin αV/β3 may be a potential receptor for embryonic adhesion in implantation. It is known that the expression of endometrial estrogen and progesterone receptors is also associated with endometrial receptivity and their levels change in chronic endometritis. Aim: The aim of this study is to investigate the level of endometrial Integrin alphaV/beta3, Prokineticin-1, Estrogen receptor (ER), Progesterone receptor (PR) expression in infertile women diagnosed with chronic endometritis and to investigate the effect of chronic endometritis on reproductive prognosis. Material-Method: ER, PR, EG-VEGF, Integrin alphaV/beta3 expression levels were evaluated and compared using immunohistochemical methods in the endometrial biopsy samples taken in the proliferative phase of 20 infertile patients diagnosed with chronic endometritis and 20 fertile women. In addition, reproductive outcomes were obtained by contacting the patients. Findings: No significant difference was found between infertile patients diagnosed with chronic endometritis and the fertile control group in terms of ER and PR. However, Glandular and stromal EG-VEGF expressions were found to be significantly higher in the chronic endometritis group compared to the control group (p:0.035, p:0.002, respectively). It was shown that EG-VEGF has a diagnostic importance for chronic endometritis. In the ROC analysis performed for the glandular EG-VEGF H-score, the cut off score was determined as 205. (AUC: 0.78, 90% of specifisity and 60% of sensitivity; 95% CI (0.621-0.895); P <0.001). Although not statistically significant, expression of both the stromal and glandular Integrin αV/β3 H-Score were lower in the chronic endometritis group than in the control group. Results: We examined the expression of estrogen and progesterone receptors, as well as integrin αV/β3 and EG-VEGF, which have never been studied before, in infertile patients with chronic endometritis. We think that our results will be effective in the diagnosis of chronic endometritis and understanding its pathophysiology. Studies with a larger sample set will be more effective in improving reproductive functions. Keywords: Chronic endometritis, endometrial receptivity, infertility, hysteroscopy, estrogen receptor, progesterone receptor, Integrin αV/β3, EG-VEGF, Prokineticin-1