التقييم الكيموحيوي لاستقبال بطانة الرحم وتقييم الجنين بين حالات التلقيح الصناعي.

Biochemical Assessment of Endometrial Receptivity and Embryo Evaluation Among Cases of In Vitro Fertilization

Background: In Vitro Fertilization (IVF) is a process where an ova is fertilized by sperm outside the body. One of the critical factors influencing the success of IVF is endometrial receptivity, which refers to the ability of the endometrium to allow an embryo to implant and develop. This study was to examine the role of the proposed markers in the IVF process by the following objectives, Estimating the level of (Mucin 1 MUC1, Growth Differentiation Factor-9 GDF-9, and Human Leucocyte Antigen HLA) in IVF cases and investigating the diagnostic preferences of the biomarkers using ROC analysis.
Patients and Methods: A cross-sectional study designed, for a total 120 Females with primary and secondary infertility were collected, blood samples were collected before IVF, and after two weeks of returning the fertilized ova. Study was conducted throughout the period from September / 2023 to August/ 2024. The College of Medicine, University of Karbala, and Karbala Health Directorate validated the study’s ethical approval. The approval also taken from the Fertility Center Al-Kafeel super-specialty hospital and from each patient after explaining the nature and purpose of the study
All participants who underwent an IVF treatment with FSH stimulation and had an evaluation of serum AMH levels before treatment were included in this study. level of Mucin, GDF9 and HLA were measured in serum, Statistical analysis was performed with SPSS and Graphical pad prism.
Results showed that Females with secondary infertility have a significantly higher mean level of both mucin (9.26%) and GDF9 (2.7%) compared to those with primary infertility (5.94% and 1.03 %, respectively). While Females with primary infertility have a highly significant higher mean HLA level (33.14%) compared to those with secondary infertility (27.34%).
Results shown an inverse link between AMH levels and Mucin levels. As AMH levels decrease across groups (A to D), the mean levels of Mucin tend to increase. The pattern for GDF9 remains similar. Group A has the lowest mean GDF9 level,
and it increases across groups B and C, a different pattern was found regarding HLA level . HLA levels consistently decrease with decreasing AMH levels (A to D). The mean Mucin level was significantly higher in the group with a positive Beta hCG test (7.59 ng/ml) compared to the negative group (6.54 ng/ml), p value was <0.05.
Similar to Mucin, the mean GDF9 level is also higher in the positive Beta hCG group (3.62 ng/ml) compared to the negative group (2.22 ng/ml) p value was <0.001. An interesting difference in biomarker levels were found among the OSI groups: It was shown that infertile women with OSI greater than 4 may have higher levels of Mucin and GDF9, and lower levels of HLA, compared to those with OSI less than 4. The mean Mucin level was higher in the group with OSI > 4 (7.23±1.87) compared to the OSI < 4 group (5.93±2.15). Similar to Mucin, the mean GDF9 level was also higher in the OSI > 4 group (3.46±3.17) compared to the OSI < 4 group (2.25±1.98) Interestingly, the mean HLA level was lower in the OSI > 4 group (18.64±6.58) compared to the OSI < 4 group (33.47±17.99).
Conclusion: The assessment of MUC1, GDF9, and HLA can provide valuable information on endometrial receptivity and embryo viability in IVF. These markers can be used to identify potential issues in implantation and guide personalized treatment strategies to improve the chances of successful pregnancy.