Unexplained Infertility Patients Present The Mostly Impaired Levels Of Progesterone Receptors: Prospective Observational Study

Problem: To assess the endometrial expression of progesterone receptors in various subgroups of infertile women during implantation window.Methods: A prospective observational study was performed during March 2013-February 2017. Infertile women were categorized to those with tubal factor, ovarian failure, endometriosis or unexplained infertility. Endometrial biopsy was obtained on 7th-8th postovulatory day. Total progesterone receptors' PR(A + B) and type-B receptors' (PR-B) expression were compared between all categories of infertile and fruitful controls.Results: There were overall 30 patients with tubal factor infertility (group 1), 30 with ovarian failure (group 2), 20 with endometriosis (group 3) and 20 with unexplained infertility (group 4). The control group consisted of 30 fertile patients. Patients with unexplained infertility presented the lowest levels of epithelial endometrial expression both regarding PR(A + B) and PR-B receptors. PgR(A + B) h-score in luminal epithelial cells was 106.4 +/- 14.7 for cases with unexplained infertility vs 219.7 +/- 15.8 for controls (P < .001). Similarly, PgR(A + B) h-score in glandular epithelial cells was 109.7 +/- 13.9 vs 220.1 +/- 17.2 (P < .001). Relative remarks were made for type-B progesterone receptors.Conclusion: Endometrial expression of progesterone receptors is impaired in women with unexplained infertility. Therapeutic strategies targeting on improving progesterone receptors' expression may significantly affect final reproductive outcome.