Changes in the Expression of Endometrial Receptivity Genes after Hysteroscopic Metroplasty in Infertile Women with Uterine Malformation

Abstract

Study Objective To determine the effect of hysteroscopic metroplasty on the expression of endometrial receptivity genes, such as HOX family and LIF gene, in infertile women with congenital uterine malformations. Design a prospective observational study conducted between June 2016 and March 2020. Setting Tertiary care University hospital in Italy. Patients or Participants Forty-four patients with a diagnosis of dysmorphic uterus or uterine septum (according to the ESHRE/ESGE classification), with history of primary unexplained infertility, repeated (>2) early miscarriages, or severe preterm labor (<25w) were enrolled in the study. Interventions All patients underwent hysteroscopic metroplasty either in office or OR settings, in the proliferative phase. Endometrial hysteroscopic biopsy was performed immediately before the metroplasty and at the two-month follow up. The endometrial samples were immediately stored at -80°C and RT-PCR was used to evaluate the expression of each gene. Measurements and Main Results The metroplasty was completed in all cases, resulting in a significant optimization of uterine morphology (44/44). After hysteroscopic metroplasty, overall, 1.05-fold increase in endometrial HOX-10 expression and overall 1.09-fold increase in endometrial HOX-11 expression were detected in comparison with baseline values. The mRNA expression level of LIF gene resulted under expressed, with a -1.12-fold decrease. Conclusion Our data demonstrate that hysteroscopic metroplasty provides favorable effect on endometrial HOXA-10 and 11 mRNA expression. These preliminary data suggest that hysteroscopic metroplasty could induce an important uterine remodeling involving not only macroscopic but also microscopic changes. To determine the effect of hysteroscopic metroplasty on the expression of endometrial receptivity genes, such as HOX family and LIF gene, in infertile women with congenital uterine malformations. a prospective observational study conducted between June 2016 and March 2020. Tertiary care University hospital in Italy. Forty-four patients with a diagnosis of dysmorphic uterus or uterine septum (according to the ESHRE/ESGE classification), with history of primary unexplained infertility, repeated (>2) early miscarriages, or severe preterm labor (<25w) were enrolled in the study. All patients underwent hysteroscopic metroplasty either in office or OR settings, in the proliferative phase. Endometrial hysteroscopic biopsy was performed immediately before the metroplasty and at the two-month follow up. The endometrial samples were immediately stored at -80°C and RT-PCR was used to evaluate the expression of each gene. The metroplasty was completed in all cases, resulting in a significant optimization of uterine morphology (44/44). After hysteroscopic metroplasty, overall, 1.05-fold increase in endometrial HOX-10 expression and overall 1.09-fold increase in endometrial HOX-11 expression were detected in comparison with baseline values. The mRNA expression level of LIF gene resulted under expressed, with a -1.12-fold decrease. Our data demonstrate that hysteroscopic metroplasty provides favorable effect on endometrial HOXA-10 and 11 mRNA expression. These preliminary data suggest that hysteroscopic metroplasty could induce an important uterine remodeling involving not only macroscopic but also microscopic changes.