Lupron

ASHEVILLE, NC. -- Ongoing research on the process of implantation suggests that those women who have the most difficulty becoming pregnant may have defects in uterine receptivity, Dr. Bruce A. Lessey said at the annual Southern Obstetric and Gynecologic Seminar.

Among women undergoing in vitro fertilization (IVF), there may be 50%-60% who become pregnant on the first try After a second attempt, the pregnancy rate may drop to about 40%, and the rate continues to diminish with each attempt. Women who fail to get pregnant on the fourth attempt may well have receptivity defects, said Dr. Lessey, professor of medicine at the University of North Carolina at Chapel Hill.

Inflammation due to hydrosalpinx or endometriosis may play a part in the lack of uterine receptivity.

The process of uterine receptivity is complex, but expression of certain biomarkers, including integrins such as [[beta].sub.3]. appears to play a role in successful implantation. Lack of these biomarkers is associated with decreased pregnancy rates; in women with endometriosis who express [[beta].sub.3], the pregnancy rate is about 70%, but those who do not express [[beta].sub.3] get pregnancy very rarely and only with IVF, Dr. Lessey said.

Evidence of the effects of inflammation was seen in a study of 85 patients with endometriosis and no expression of [[beta].sub.3].

Of 38 women who were untreated, very few became pregnant; of 25 who underwent laser surgery for the endometriosis, 40% became pregnant; and of 23 treated with Lupron for 3 months to relieve inflammation, nearly 70% became pregnant, usually on their own within the first 3 months after treatment, Dr. Lessey said.

It appeared in this study that the inflammatory components of the endometriosis were alleviated by Lupron therapy, [[beta].sub.3] began to be expressed, and implantation was able to occur within the appropriate window of opportunity. The effect of the Lupron was temporary, however, and those who delayed attempts to become pregnant were less successful.

While the mechanisms for these effects are not well understood, researchers are beginning to get a handle on the problem of uterine receptivity, Dr. Lessey said.

"This problem may not be common in the general population, but it is important for us to acknowledge that these patients exist because when we treat for infertility and they don't conceive, this may be where we should be looking," he said.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group