Glycodelin in endometrial flushing fluid and endometrial biopsies from infertile and fertile women, and their relation to pregnancy after IVF

Abstract

OBJECTIVE: To investigate glycodelin levels in endometrial flushing fluids and biopsies in fertile and infertile women prior to IVF treatment. DESIGN: Prospective observational study. MATERIALS AND METHODS: Patients: 75 infertile and 21 fertile women. All women were between 25 and 38 years of age, and had a normal body mass index (BMI) (19-26 kg/m2), regular periods (21-35 days), cigarette smoking < 10 cigarettes daily, and no hormonal treatments in the last 3 cycles before inclusion. The infertile patients were categorized into the following groups: tubal factor group (25 women with tubal factor infertility without hydrosalpinges, 18 women with hydrosalpinges present, 17 women after salpingectomy) unexplained infertility (15 women with normal plasma FSH, LH, prolactin and TSH on cycle day 2-5 and a normal HSG) and fertile reference group (21 women with a history of having delivered at least one child and no recurrent spontaneous abortions). The women were investigated twice in one cycle: Day LH+1: endometrial flushing. Day LH+7: endometrial flushing, endometrial biopsy and plasma glycodelin. Main outcome measures: Glycodelin levels in endometrial flushing fluids, biopsies and plasma, compared to endometrial dating and IVF outcome. RESULTS: Glycodelin levels in endometrial flushing fluids and biopsies at day LH+7 depended on endometrial dating, whereas day LH+1 flushing levels were independent. Infertile women demonstrated higher flushing levels than fertile women at day LH+1. Women conceiving after IVF had higher glycodelin levels than non-pregnant fertile women. Logistic regression analysis showed that the day LH+1 glycodelin levels were on the limit of being significant (p=0.05). Glycodelin in plasma had no predictive value. We found significant differences in protein concentrations in flushing fluids at day LH+1; levels being higher in flushing fluids from delayed endometria. CONCLUSIONS: Glycodelin is detectable already at day LH+1 in endometrial flushing fluid. It is independent of endometrial histological maturation and, alone or together with other parameters, may be a valuable predictor of subsequent pregnancy. Day LH+7 levels need an endometrial biopsy for correct evaluation. Spontaneous cycle plasma glycodelin has no predictive value.