Implication of soluble endothelial C protein receptor in IVF embryo implantation failure

Abstract

OBJECTIVE: Soluble endothelial cell protein C receptor (EPCRs) is involved in protein C system activation and associated with ischemic stroke risk and late foetal losses. The aim of this study is to determine if its expression is modified in patients with IVF embryo implantation failure. DESIGN: Prospective study approved by the local Institutional Review Board. MATERIALS AND METHODS: 87 patients were referred to the Center because of two previous IVF failures. Blood samples were taken in follicular phase before the third attempt. Patient who conceived after the third IVF (groupe 1) were compared with women who did not become pregnant (groupe 2). All those women (groupe 1 and 2) were age matched with 41 healthy women who have spontaneously conceived and delivered healthy children (groupe 3). EPCRs, pregnancy rates. For statistical analysis, Student's t test was applied and data were expressed as mean ± SD. Because normal distribution of data could not be assumed, the non parametric tests for paired (Wilcoxon) and unpaired (Mann-Whitney U-test) samples were used. P-values of < 0.05 were considered to be statistically significant. RESULTS: Among the 87 patients, 24 became pregnant (group 1) whereas 62 failed to conceive (group 2) after the third IVF. EPCRs in infertile patients (N=87) was about 141 ± 107 ng/ml. mean EPCRs in group 1 (n= 24) was about 102 ± 32 ng/ml while it was about 156 ± 121 ng/ml in group 2 (n=62). In healthy women (group 3; n=41) the mean value of EPCRs is 94 ± 62 ng/ml. The difference is statistically significative between the two infertile groups (p < 0.018), between infertile who conceived after IVF and women who conceived spontaneously (p<.0.007) and between women who did not conceived and women who conceived spontaneously (p<.0.0001). IVF failure risk calculated for a EPCRs upper 200 ng/ml is near 5.7 with IC 95% [1.2 – 22.6]. CONCLUSIONS: EPCRs is statistically more elevated in patients who experience IVF embryo implantation failure. This study need more patients to improve those results and identify mechanisms associated with EPCR and in embryo implantation.