#6 : Effects of Co-Treatment of GnRH-Analog Alone or in Combination with Aromatase Inhibitor or Progestin on Endometrial - Integrin Expressions in Women with Recurrent Miscarriage

Abstract

Background and Aims: Recurrent miscarriage (RM) is postulated caused by endometrium receptivity. We aimed to assess the expression of ανβ3 integrin in endometrium tissue during the window of implantation (WOI) following GnRH analog alone or in combination with either aromatase inhibitor (AI) or progestin (PrG) to consolidate the outcome. Method: A randomized control trial (RCT) was done in Hospital Canselor Tuanku Muhriz (HCTM) UKM. Women with RM were divided into three groups - Group I-GnRHa, Group II–GnRHa + AI, or Group III–GnRa + PrG. The endometrial tissue biopsy was taken during the luteal phase (between LH+7 and LH+9), then repeated biopsy post-treatment. The ανβ3 integrin expression was evaluated for pre- and post-treatment. The intensity and distribution in endometrial glands were done using HSCORE system. Results: 39 women with RM were included with 13 in each group. The mean age was older in Group I; 38.00 ± 4.9 years old with mean BMI of 25.7 ± 2.44 kg/m2. Group II had significantly the highest intensity and distribution of ανβ3 integrin expression > 50 following the treatment; from 28.6% to 42.9% (p < 0.05), and an increase in HSCORE following the treatment from 1.82 ± 0.70 to 2.36 ± 0.56 (p < 0.05). Meanwhile, Group I HSCORE noted was elevated; from 1.90 ± 0.91 to 2.29 ± 0.77, and Group III was also elevated from 1.67 ± 0.77 to 1.90 ± 0.87. However, all were not statistically significant (p > 0.05). Conclusion: The ανβ3 integrin expression can be significantly elevated with GnRHa and AI as pre-treatment, thus aiming for better implantation results among women with RM.