Recent studies are directed to decode the genetic signature of endometrial receptivity for better outcomes in assisted reproductive technologies. In this study, we aimed to understand the transcriptomic profile of midsecretory phase endometria of patients with recurrent pregnancy losses (RPL) and unexplained infertility (UI) by comparing with the endometria of healthy fertile women (Controls). In this prospective cohort study, we took endometrial samples from 24 patients with RPL, 24 patients with UI and 24 Controls at day 19-21 of the menstrual cycle. By performing genomic analysis, we assessed for differentially expressed genes (DEGs) and pathway analysis.
Overall design
All patients involved in this prospective cohort study were recruited from Istanbul University School of Medicine between August 2014 and August 2015. Three cohorts (fertile controls, patients with RPL and UI) were studied and 24 patients were included in each cohort. None of the patients has received a prior infertility treatment and were not under a current treatment. The first cohort comprised fertile control patients who presented to our gynecology department for well woman examinations. The inclusion criteria were regularly cycling women aged under 35 years with at least one live birth, no history of infertility/treatment, no previous miscarriages and no associated gynecologic (endometriosis, fibroids, active or history of pelvic inflammatory disease) or other medical comorbidities (hyperprolactinemia, thyroid disease etc). The remaining cohorts constituted patients who presented to our in vitro fertilization (IVF) unit. The second cohort included patients with RPL with no history of successful pregnancies. The inclusion criteria for this group were regularly cycling women aged under 35 years with at least two consecutive pregnancy losses of 20 weeks or less, normal follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and thyroid-stimulating hormone (TSH) levels at day 2-3, normal uterine cavity shape and size, and bilateral tubal patency observed on hysterosalpingogram, no mutations detected in Factor V (Leiden) and prothrombin gene analysis, normal antithrombin III, protein C and S activity, negative results for lupus anticoagulant evaluation, cardiolipin antibody (IgM and IgG), and beta2-glycoprotein antibody (IgM and IgG) and normal karyotype. Their partners have normal spermiogram results and normal karyotype. The third cohort was formed by women with UI at least of 18 months of duration. The inclusion criteria for this group were regularly cycling women aged under 35 years with normal FSH, LH, E2, PRL, and TSH levels at day 2-3, normal uterine cavity shape and size, and bilateral tubal patency observed on a hysterosalpingogram. Their partners have normal spermiogram results.
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