Use of integrins to date the endometrium

Objective: To compare traditional histologic dating criteria of the endomet rium with immunohistochemical criteria based on epithelial integrin express ion during the menstrual cycle. Design: Prospective clinical study. Setting: An academic teaching hospital. Patient(s): Fertile and infertile women undergoing endometrial biopsy. Main Outcome Measure(s): Immunohistochemical staining intensity and distrib ution (HSCORE) of three integrins and traditional histologic endometrial da ting. Result(s): In 1,501 endometrial specimens, phase assignment-based integrin staining was 95% and 85% concordant with histology for the proliferative an d early secretory phase, respectively, but only 54% and 49% concordant for the middle and late secretory phase, respectively. The greatest disagreemen t occurred during the midluteal phase. Of 1,090 patients who underwent samp ling 6-10 days after detection of a urinary LH surge (corresponding to cycl e days 20-24), multiple logistic regression analysis revealed that endometr iosis was positively correlated and male factor infertility was negatively correlated with absent beta 3 integrin subunit expression. Diagnosis and ab sent epithelial alpha 4 beta 1 expression were not related. Patient age was not correlated with the incidence of abnormalities in integrin expression. Conclusion(s): Traditional histologic dating of the endometrium has remaine d the gold standard for nearly 50 years. Although the use of marker protein s provides additional information and may reflect endometrial function or r eceptivity, such markers cannot yet replace traditional methods of endometr ial assessment. (C) 2000 by American Society for Reproductive Medicine.