Proinflammatory cytokines induced altered expression of cyclooxygenase-2 gene results in unreceptive endometrium in women with idiopathic recurrent spontaneous miscarriage

Objective: To investigate the expression pattern of proinflammatory, anti-inflammatory, and angiogenic cytokines and their effect on various mediators of endometrial receptivity in women with idiopathic recurrent spontaneous miscarriage (IRSM). Design: A prospective study. Setting: Tertiary care hospital and reproductive health research unit. Patient(s): Thirty-six women with IRSM (< 35 years) and 30 fertile women as controls matched by age and body mass index undergoing sterilization. Intervention(s): Endometrial biopsies in all women corresponding to the window of implantation. Main Outcome Measure(s): Assessment of endometrial expression of proinflammatory, anti-inflammatory, and angiogenic cytokines, mediators of matrix turnover and angiogenesis, markers of receptivity. Result(s): A statistical significantly higher level of proinflammatory cytokines, mediators of matrix turnover and angiogenesis, and a reduced expression of anti-inflammatory and angiogenic cytokines were observed in women with IRSM. Additionally, the markers of endometrial receptivity were poorly expressed in women with IRSM. Conclusion(s): Aberrant expression of proinflammatory, anti-inflammatory, and angiogenic cytokines during implantation window in women with IRSM is one of the key factors that adversely affect endometrial development, as evidenced by the inadequate expression of various endometrial receptivity markers. (Fertil Steril (R) 2013;99:179-87. (C) 2013 by American Society for Reproductive Medicine.)