Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus.

OBJECTIVE: To evaluate the obstetrical and oncological progression of twin pregnancies with hydatidiform mole coexisting fetus (HMCF). MATERIALS AND METHODS: Using a retrospective method based on patients from the Women's Hospital, Zhejiang University School of Medicine database between January 1990 and October 2020, 17 patients were histologically confirmed as having HMCF, and the patients' prenatal diagnosis, outcomes and development of gestational trophoblastic neoplasia (GTN) were reviewed. RESULTS: Among these 17 cases, 11 (64.71%) cases were complete hydatidiform mole coexisting fetus (CHMCF), and 6 (35.29%) cases were partial hydatidiform mole coexisting fetus (PHMCF). The gestational age at diagnosis of CHMCF was significantly earlier than that of PHMCF [9 (8-24) vs. 18 (11-32) weeks, respectively, P < 0.05]. The live birth rate of PHMCF was slightly higher than that of CHMCF (33.33%; 18.18%), but this difference was not statistically significant. The overall rate of GTN incidence of HMCF was 47.06% (8/17), and the GTN rates of PHMCF and CHMCF were 33.33% (2/6) and 54.55% (6/11), respectively. There was no significant difference in the GTN rate between patients who chose to continue pregnancy and those who terminated pregnancy before 24 weeks of gestation. The GTN rate of patients with term delivery was not significantly higher than that of preterm delivery. CONCLUSION: In HMCF cases, the incidence rate of CHMCF was higher than that of PHMCF, and PHMCF is more difficult to diagnose in the early stage. Continuing pregnancy does not increase the risk of GTN compared to terminating pregnancy. In cases of HMCF, when the fetal karyotype is normal and maternal complications are controlled, it is safe to continue the pregnancy and extend it to term.

Extrauterine epithelioid trophoblastic tumors presenting as lung mass: A case report and literature review.

RATIONALE: Extrauterine epithelioid trophoblastic tumors (ETT) is a rare variant of gestational trophoblastic neoplasms. Here we aim to learn more clinical and pathological characteristics of ETT patient with an isolated pulmonary mass without uterine lesions, through a rare case of extra-uterine ETT and 7 cases published in English periodicals literature. PATIENT CONCERNS: A 31-year-old Chinese woman, presented with low-level elevation of serum human chorionic gonadotropin (HCG) for more than 2 years without abnormal symptoms. Dilation and curettage (D&C) was performed and histopathology revealed a secretory phase of endometrium. Chest computed tomography (CT) scan showed a 0.8 cm nodular lesion in the upper left lobe. Then a thoracotomy with left upper lobe segmentectomy was performed. DIAGNOSIS: After pathological and immunohistochemistry diagnosis, the case was confirmed as ETT (III). INTERVENTIONS: According to FIGO guideline, the patient took 3 cycles of multivalent chemotherapy consisting of cisplatin and etoposide, alternating with etoposid, methotrexate dactinomycin (EP-EMA). OUTCOMES: The patient had no obvious signs of recurrence after 13 months of follow-up. LESSONS: When a fertile age woman persistently shows abnormal low-level escalation of HCG, ETT should be taken into consideration, especially lung X-ray or CT showing lesions without apparent abnormality of the uterus.

Aquaporin 5 Plays a Role in Estrogen-Induced Ectopic Implantation of Endometrial Stromal Cells in Endometriosis.

Aquaporin 5 (AQP5) participates in the migration of endometrial cells. Elucidation of the molecular mechanisms associated with AQP5-mediated, migration of endometrial cells may contribute to a better understanding of endometriosis. Our objectives included identifying the estrogen-response element (ERE) in the promoter region of the AQP5 gene, and, investigating the effects of AQP5 on ectopic implantation of endometrial cells. Luciferase reporter assays and electrophoretic mobility shift assay (EMSA) identified the ERE-like motif in the promoter region of the AQP5 gene. After blocking and up-regulating estradiol (E2) levels, we analysed the expression of AQP5 in endometrial stromal (ES) cells. After blocking E2 /or phosphatidylinositol 3 kinase(PI3K), we analysed the role of AQP5 in signaling pathways. We constructed an AQP5, shRNA, lentiviral vector to knock out the AQP5 gene in ES cells. After knock-out of the AQP5 gene, we studied the role of AQP5 in cell invasion, proliferation, and the formation of ectopic endometrial implants in female mice. We identified an estrogen-response element in the promoter region of the AQP5 gene. Estradiol (E2) increased AQP5 expression in a dose-dependent fashion, that was blocked by ICI182,780(an estrogen receptor inhibitor). E2 activated PI3K /protein kinase B(AKT) pathway (PI3K/AKT), that, in turn, increased AQP5 expression. LY294002(PI3K inhibitor) attenuated estrogen-enhanced, AQP5 expression. Knock-out of the AQP5 gene with AQP5 shRNA lentiviral vector significantly inhibited E2-enhanced invasion, proliferation of ES cells and formation of ectopic implants. Estrogen induces AQP5 expression by activating ERE in the promoter region of the AQP5gene, activates the PI3K/AKT pathway, and, promotes endometrial cell invasion and proliferation. These results provide new insights into some of the mechanisms that may underpin the development of deposits of ectopic endometrium.

[AQP5 gene silencing inhibits proliferation and migration of ectopic endometrial glandular epithelial cells in endometriosis].

OBJECTIVE: To investigate the effect of aquaporin 5(AQP5) on proliferation and migration of ectopic endometrial epithelial cells. METHODS: AQP5 shRNA interference fragments were designed and transfected into ectopic endometrial epithelial cells stably by lentivirus technology. Fluorescence quantitative RT-PCR and Western blotting were used to detect the AQP5 mRNA and protein expression, respectively. The cell proliferation and migration were determined by using MTT method and Transwell system, respectively. Levels of phosphorylated AKT(p-AKT) and total AKT were examined by Western blotting. The nude mice model of endometriosis was constructed and the endometrial cell nodule formation was observed. RESULTS: AQP5 shRNA transfection inhibited cell proliferation and migration compared with control group (both P<0.05). The activation of AKT in AQP5 shRNA transfected cells was lower than that in control cells (P<0.01). Compared to control group, the endometrial cells nodule formation was suppressed in mice inoculated with AQP5 shRNA-silencing ectopic endometrial epithelial cells. CONCLUSION: Down-regulation of AQP5 expression can suppress the proliferation and migration of ectopic endometrial epithelial cells and endometrial cell nodule formation in nude mice, in which AKT pathway may be involved.

Severe Henoch-Schönlein purpura with infliximab for ulcerative colitis.

Infliximab (IFX) is an anti-tumor necrosis factor chimeric antibody that is effective for treatment of autoimmune disorders such as Crohn's disease and ulcerative colitis (UC). IFX is well tolerated with a low incidence of adverse effects such as infections, skin reactions, autoimmunity, and malignancy. Dermatological manifestations can appear as infusion reaction, vasculitis, cutaneous infections, psoriasis, eczema, and skin cancer. Here, we present an unusual case of extensive and sporadic subcutaneous ecchymosis in a 69-year-old woman with severe UC, partial colectomy and cecostomy, following her initial dose of IFX. The reaction occurred during infliximab infusion, and withdrawal of IFX led to gradual alleviation of her symptoms. We concluded that Henoch-Schönlein purpura, a kind of leukocytoclastic vasculitis, might have contributed to the development of the bruising. Although the precise mechanisms of the vasculitis are still controversial, such a case highlights the importance of subcutaneous adverse effects in the management of UC with IFX.

Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux.

AIM: To assess the diagnostic value of a combination of intragastric bile acids and hepatobiliary scintigraphy in the detection of duodenogastric reflux (DGR). METHODS: The study contained 99 patients with DGR and 70 healthy volunteers who made up the control group. The diagnosis was based on the combination of several objective arguments: a long history of gastric symptoms (i.e., nausea, epigastric pain, and/or bilious vomiting) poorly responsive to medical treatment, gastroesophageal reflux symptoms unresponsive to proton-pump inhibitors, gastritis on upper gastrointestinal (GI) endoscopy and/or at histology, presence of a bilious gastric lake at > 1 upper GI endoscopy, pathologic 24-h intragastric bile monitoring with the Bilitec device. Gastric juice was aspirated in the GI endoscopy and total bile acid (TBA), total bilirubin (TBIL) and direct bilirubin (DBIL) were tested in the clinical laboratory. Continuous data of gastric juice were compared between each group using the independent-samples Mann-Whitney U-test and their relationship was analysed by Spearman's rank correlation test and Fisher's linear discriminant analysis. Histopathology of DGR patients and 23 patients with chronic atrophic gastritis was compared by clinical pathologists. Using the Independent-samples Mann-Whitney U-test, DGR index (DGRi) was calculated in 28 patients of DGR group and 19 persons of control group who were subjected to hepatobiliary scintigraphy. Receiver operating characteristic curve was made to determine the sensitivity and specificity of these two methods in the diagnosis of DGR. RESULTS: The group of patients with DGR showed a statistically higher prevalence of epigastric pain in comparison with control group. There was no significant difference between the histology of gastric mucosa with atrophic gastritis and duodenogastric reflux. The bile acid levels of DGR patients were significantly higher than the control values (Z: TBA: -8.916, DBIL: -3.914, TBIL: -6.197, all P < 0.001). Two of three in the DGR group have a significantly associated with each other (r: TBA/DBIL: 0.362, TBA/TBIL: 0.470, DBIL/TBIL: 0.737, all P < 0.001). The Fisher's discriminant function is followed: Con: Y = 0.002TBA + 0.048DBIL + 0.032TBIL - 0.986; Reflux: Y = 0.012TBA + 0.076DBIL + 0.089TBIL - 2.614. Eighty-four point zero five percent of original grouped cases were correctly classified by this method. With respect to the DGR group, DGRi were higher than those in the control group with statistically significant differences (Z = -5.224, P < 0.001). Twenty eight patients (59.6%) were deemed to be duodenogastric reflux positive by endoscopy, as compared to 37 patients (78.7%) by hepatobiliary scintigraphy. CONCLUSION: The integrated use of intragastric bile acid examination and scintigraphy can greatly improve the sensitivity and specificity of the diagnosis of DGR.

A multiple perspectives on atypical polypoid adenomyoma of uterus.

Atypical polypoid adenomyoma (APA) is a rare benign uterine tumor, with less than 200 cases have been reported in English literature. Although, it is considered as a benign lesion and treated conservatively previously, more and more cases show that APA has a high rate of recurrence or residual, and is found to precede the development of carcinoma. Given the data from present research on APA, the therapy of APA becomes more complex and must be cautious, especially for the nulliparous and premenopausal patients. In addition, because of the low incidence, studies on this disease are less, and the etiology and pathogenesis of APA is still unclear. In this review, we aim to summarize recent researches concerning APA from multiple perspectives, including clinical presentation, histogenesis, immunohistochemistry and molecular features, diagnosis and differential diagnosis, treatment opinion and prognosis, which may provide theory and clinical basis for the future clinical treatment and research of this rare disease.

Reduced migration of Ishikawa cells associated with downregulation of aquaporin-5.

Aquaporin (AQP)-dependent cell migration has broad implications in angiogenesis, tumor metastasis, wound healing, glial scarring and other events requiring cell movement. There are 13 isoforms of AQP (0-12) that have been identified in mammals. It is unclear whether AQP5 plays a role in the development of endometrial cancer. We recently demonstrated that ovarian steroids may affect the expression of AQP5 in the female genital tract. In this study, we considered whether AQP5 may affect cell migration in Ishikawa cells, an adenocarcinoma cell line derived from the endometrium. The results showed that the downregulation of AQP5 results in reduced Ishikawa cell migration. The estrogen (E2) receptor in the promoter of AQP5 mediated the regulation of AQP5 expression in the normal endometrium and endometrial cancer. By contrast, the upregulation of AQP5 by E2 increased cell migration, invasion and adhesion through increased annexin-2, which is responsible for F-actin remodeling and rearrangement. E2 regulates Ishikawa cell migration by regulating the AQP5 expression.

RNAi-mediated blocking of ezrin reduces migration of ectopic endometrial cells in endometriosis.

Ezrin is a member of the ezrin-radixin-moesin (ERM) family of membrane-cytoskeletal linkage proteins. It is important for maintenance of cell shape, adhesion, migration and division. The overexpression of ezrin in some tumours is associated with increased cell migration that is mediated by the Rho/ROCK family of small GTPases. To investigate the role of ezrin in the migration of ectopic endometrial cells in endometriosis, we conducted real-time quantitative RT-PCR analysis of the eutopic and ectopic endometrium from women with endometriosis compared with those without the disease. RNAi, wound healing assays and western blot analysis of endometriotic cells were also included in this research. We found significantly higher levels of mRNA expression of ezrin (0.42 versus 0.27, P < 0.05), RhoA (0.99 versus 0.74, P < 0.05), RhoC (0.79 versus 0.43, P < 0.005) and ROCK1 (0.68 versus 0.38, P < 0.005) in the ectopic endometrial cells compared with the eutopic endometrial cells in endometriosis. Blocking ezrin with small-interfering RNA reduced the migration of ectopic endometrial cells with decreased expression of RhoA (42.68%), RhoC (58.42%) and ROCK1 (59.88%). Our results indicate that the over-expression of ezrin in endometriosis may play a significant role in the migration of endometrial cells of endometriosis, and the RhoC/Rock pathway may provide a promising treatment target.

Growth mechanisms of endometriotic cells in implanted places: a review.

Endometriosis is a common gynecological disease defined by extrauterine growth of endometrial glands and stroma. A variety of theories have been proposed to account for the pathogenesis of this disease, including retrograde transplantation theory, metaplasia of coelomic epithelium, hematogenic and lymphogenic spread, and remnants of the Mullerian duct. However, the etiopathology of endometriosis is still obscure. In this article, we aim to summarize recent researches concerning the growth mechanisms of endometriotic cells in implanted sites systematically, including the adhesion, invasion, angiogenesis, proliferation, apoptosis of endometriotic cells, variations of the immune molecules and endometriotic cells themselves, which may provide clues for future researches in the pathogenesis of endometriosis.

[Effects of PRL-3 siRNA on the migration of endometriotic stromal cells].

OBJECTIVE: To evaluate the effects of PRL-3 siRNA (small interfering RNA) on the migration of endometriotic stromal cells. METHODS: Primary endometriotic stromal cells were cultured in vitro. Then PRL-3 (phosphatase of regenerating liver-3) siRNA was transfected to silence the PRL-3 gene. And the PRL-3 protein expression was analyzed by Western blot. The changes of cell migration were detected by cell pseudopod formation, scratch test and transwell cell migration test. RESULTS: The expression of PRL-3 protein significantly decreased in the experimental group versus two other control groups (P < 0.05). The formation of cell pseudopod was much less in experimental group than that in control groups. Within the same time, the number of migration cells was 0.87 ± 0.21 in experimental group. It was less than 1.75 ± 0.28 in blank control group and 1.63 ± 0.39 in negative control group (P < 0.05). CONCLUSION: PRL-3 siRNA can down-regulate the PRL-3 gene and decrease the migratory capacity of endometriotic stromal cells. And PRL-3 may be a promising target in the therapeutics of endometriosis.

Phosphatase of regenerating liver-3: a novel and promising marker in human endometriosis.

OBJECTIVE: To investigate the expression of phosphatase of regenerating liver-3 (PRL-3) in ectopic, eutopic, and normal endometria and explore its relationship with endometriosis. DESIGN: A clinical retrospective and molecular study. SETTING: Department of obstetrics, gynecology, and reproductive medicine. PATIENT(S): One hundred and five women with histopathologically confirmed endometriosis, and 50 women with histopathologically assessed normal endometria. INTERVENTION(S): Immunohistochemical staining and Western blot analysis. MAIN OUTCOME MEASURE(S): Expression of PRL-3 protein. RESULT(S): As shown by the immunohistochemical analysis, PRL-3 was mainly located in the cytoplasm and membrane. The cells that tested positive for PRL-3 were detected in endometriotic tissues that did not occur in eutopic and normal endometria. Statistical analysis indicated that the expression of PRL-3 was closely associated with the clinical stages and recurrence of endometriosis. CONCLUSION(S): Expression of PRL-3 is related to the clinical stages and recurrence of endometriosis, which provides use with a novel marker and promising target in the treatment of human endometriosis.

Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage.

A case of single large cystic adenomyoma of the uterus (anechoic area 1.6 cm in diameter) was diagnosed by surgery and histopathologic analysis more than 3 years after a transcervical curettage for an early right-cornual pregnancy.

Clinicopathologic characteristics of uterine adenomyoma in pregnant women.

OBJECTIVE: To study the clinicopathologic characteristics and the treatment means of pregnant women with uterine adenomyoma. DESIGN: Retrospective, consecutive, controlled study. SETTING: University hospital for obstetrics and gynecology. PATIENT(S): Eighteen pregnant women with uterine adenomyoma. INTERVENTION(S): Data collection and statistical analysis. MAIN OUTCOME MEASURE(S): Eighteen pregnant women with uterine adenomyoma were diagnosed by excision of adenomyoma tissue during cesarean section and histopathology. The 18 subjects were retrospectively divided into treatment group (achieving this pregnancy by treatment; 10 cases) and control group (having no difficulty conceiving; 8 cases). The clinicopathologic characteristics and treatment means of the patients were analyzed retrospectively. RESULT(S): The mean volume of uterine adenomyoma in the treatment group was larger than that of the control group. The methods of treating women with uterine adenomyoma-associated infertility include GnRH agonist (GnRH-a: 6 cases), GnRH-a and IVF and embryo transfer (3 cases), and traditional Chinese medicines (1 case). CONCLUSION(S): Severe uterine adenomyoma correlate with infertility in women of childbearing age. GnRH-a is effective in treating women with uterine adenomyoma-associated infertility.

[Effect of yangjing zhongyu decoction on matrix metalloproteinase-9 expression in endometrium and sex hormone regulation in women with cryptogenic infertility].

OBJECTIVE: To investigate the effect of Yangjing Zhongyu decoction (YZD) on metalloproteinase-9 (MMP-9) and its inhibitor-1 (TIMP-1) expression and sex hormone regulation in mid-luteal phase endometrium of women with cryptogenic infertility. METHODS: In situ hybridization and reverse transcription-polymerase chain reaction method was used to detect MMP-9 and TIMP-1 mRNA, and radioimmunoassay was used to determine levels of serum estradiol (E2) and progesterone (P) synchronously, of 22 infertile women during mid-luteal phase. RESULTS: After treatment, the mid-luteal serum E2 and P level was 451.501 +/- 226.342 pmol/L and 46.502 +/- 19.948 nmol/L respectively, significantly higher than that before treatment (304.656 +/- 135.853 pmol/L and 33.782 +/- 15.459 nmol/L respectively), the difference was significant (P < 0.01). Staining of MMP-9 mRNA positive granules in cytoplasm and nuclei of adeno-epithelial cell mid-luteal phase endometrium deepened significantly, but the change in mesenchym was insignificant. The MMP-9 mRNA expression after treatment was 0.617 +/- 0.186 (grey level), significantly higher than the level before treatment (0.490 +/- 0.370), comparison between them showed significant difference (P < 0.05). Change of TIMP-1 mRNA expression in adeno-epithelial and mesenchym before and after treatment was insignificant (0.588 +/- 0.191 vs 0.621 +/- 0.146, P < 0.05). Correlation analysis showed that the quantitative difference of P value before and after treatment was positively correlated with the difference of MMP-9 mRNA before and after treatment (r = 0.682, P < 0.01). CONCLUSION: YZD could soothen Gan and nourish Shen, raise the level of mid-luteal phase serum P, and further promote MMP-9 gene expression in endometrium to benefit the degradation of extracellular matrix of endometrium, and facilitate for blastocyst implantation.

[Insulin-like growth factor II and its receptor gene expression in the endometrium of women with unexplained infertility].

OBJECTIVE: To investigate the expression of insulin-like growth factor II (IGF-II) and its type I receptor (IGF-IR) and type II receptor (IGF-IIR) in the endometrium of women with unexplained infertility and their relation to steroid levels. METHODS: In situ hybridization method was utilized to detect the location of IGF-II, IGF-IR and IGF-IIR mRNA. Reverse transcription-polymerase chain reaction (RT-PCR) method was employed to detect quantitatively IGF-II, IGF-IR, and IGF-IIR mRNA expression levels in the endometrium during mid-luteal phase. Serum concentrations of estradiol and progesterone were measured by radioimmunoassay. Thirty-eight patients with unexplained infertility were included as study group, and 20 patients with men factor infertility or normal volunteer women were selected as control group. RESULTS: IGF-II and IGF-IIR mRNA were diffusely distributed in the cytoplasm of stromal cells and IGF-IR mRNA was observed in the cytoplasm of epithelial cells. Endometrial IGF-II, IGF-IR and IGF-IIR mRNA expression during mid-luteal phase in study group were significantly lower than those in the control group respectively (0.71 +/- 0.34 vs 0.96 +/- 0.34, P < 0.05; 0.62 +/- 0.28 vs 0.93 +/- 0.51, P < 0.05; 0.49 +/- 0.27 vs 0.73 +/- 0.36, P < 0.05). The serum progesterone level of study group was significantly lower than that of control group, (34 +/- 15) nmol/L vs (53 +/- 17) nmol/L (P < 0.05). The levels of IGF-II mRNA were positively correlated with IGF-IR mRNA and IGF-IIR mRNA in both groups. There were significant positive correlations between serum progesterone level and IGF-II, IGF-IR and IGF-IIR mRNA. CONCLUSIONS: IGF-II and its receptors mRNA play important roles in the process of implantation. Their decreased expression in relation with lower progesterone level may be one of the major causes of unexplained infertility.

[Expression of matrix metalloproteinases-9 and tissue inhibitor of metalloproteinases-1 mRNA in the endometrium during mid- luteal phase in women with unexplained infertility].

OBJECTIVE: To investigate the expression of matrix metalloproteinases-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) mRNA in the endometrium during mid-luteal phase in women with unexplained infertility and its steroidal regulation. METHODS: In situ hybridization method was utilized to detect the location of MMP-9 and TIMP-1 mRNA. Reverse transcription polymerase chain reaction (RT-PCR) method was utilized to detect and quantitate MMP-9 and TIMP-1 mRNA expression levels in the endometrium during mid-luteal phase. Serum concentration of estradiol (E(2)) and progesterone (P) were measured by radioimmunoassay. Thirty-eight patients with unexplained infertility were included as study group, and 20 women with male factor infertility or normal volunteers were selected as control group. RESULTS: MMP-9 and TIMP-1 mRNA were diffusely distributed in the cytoplasm and nuclei of glandular and stromal cells. Their staining in control group were more abundant than those in study group. Endometrial MMP-9 and TIMP-1 mRNA expression during mid-luteal phase showed by RT-PCR in the study group were significantly lower than those in the control group (0.42 +/- 0.19 Vs 0.57 +/- 0.19, P < 0.05; 0.59 +/- 0.19 Vs 0.81 +/- 0.20, P < 0.01 respectively). Serum P of the study group was significantly lower than that of control group [(34 +/- 15) nmol/L Vs (53 +/- 17) nmol/L, P < 0.01]. Serum P level was positively correlated with MMP-9 mRNA only in control groups. CONCLUSIONS: MMP-9 and TIMP-1 mRNA might play an important role in the process of implantation. The decreased expression of their gene related to P level might be one of the major causes in unexplained infertility.

[Effect of yangjing zhongyu decoction on expression of insulin-like growth factor II and its receptor in endometrium of women with unexplained infertility].

OBJECTIVE: To investigate the effect of Yangjing Zhongyu Decoction (YJZYD) on expression of insulin-like growth factor II (IGF-II) and its receptor II (IGF-II R) in endometrium of women with unexplained infertility, and the relationship of which with the receptibility of endometrium to ovum implantation. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) assay was used to detect quantitatively the expression of IGF-II and IGF-II R in 22 women with unexplained infertility before and after YJZYD treatment during mid-luteal phase. RESULTS: The levels of IGF-II and IGF-II R before treatment were 0.794 +/- 0.453 and 0.725 +/- 0.354 (in grey level, the same below) respectively, which were significantly increased in the same phase after treatment, reaching 1.202 +/- 0.551 and 1.045 +/- 0.581 respectively (P < 0.01 and P < 0.05). Correlation analysis showed the level of IGF-II mRNA was positively correlated with the level of IGF-II mRNA either before or after treatment. CONCLUSION: YJZYD could enhance the expression of IGF-II and IGF-II R in the endometrium during mid-luteal phase, promote the differentiation of endometrium and increase its reception to ovum implantation.

[Endometrial insulin-like growth factor II and type I receptor in unexplained infertility and its steroid regulation]

OBJECTIVE: To investigate the endometrial expression of insulin-like growth factor II(IGF-II) and type I receptor(IGF-1R) in unexplained infertility. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect and quantify endometrial IGF-II and IGF-I R mRNA experession in the mid-luteal phase. Serum concentrations of estradiol(E(2)) and progesterone (P) were measured by radioimmunoassays. Thirty-four women with unexplained infertility were included in the study group. Twenty-one women with normal fertility were selected as the control group. RESULTS: Endometrial IGF-II and IGF-I R mRNA experession during the midluteal phase were significantly lower in the study group than in the control group (0.662 +/- 0.371 compared with 0.961+/- 0.389, P< 0.05; 0.582 +/- 0.257 compared with 0.829 +/-0.341, P< 0.05 respectively). The average serum P level in the study group was significantly lower than in the control group (23.782 +/-15.459 compared with 43.142 +/- 16.549nmol/L, P< 0.005). IGF-II mRNA expression correlated positively with IGF-I R mRNA expression in the two groups. Serum P level correlated positively with IGF-II and IGF-I R mRNA expression in the two groups. CONCLUSION: IGF-II and IGF-I R may play an important role in the implantation process. Their decreased expression relating to decreased P level may be important in unexplained infertility.