Endometrial CD4+ And CD8+ in Women with Failed Implantation Following Embryo Transfer

To quantify and compare endometrial CD4+ and CD8+ cells in women with failed implantation following embryo transfer and infertile women using immunohistochemistry. It was a case control study that was done at Al-Amin Maternity Hospital, Saudi Arabia. Endometrial biopsies were collected from women who failed to achieve pregnancy after repeat IVF treatment from start of January 2013 till December 2014 in IVF centers, endometrial biopsies were collected in mid luteal phase of cycle. A second group of matched fertile women, and came to outpatient clinic for reasons other than infertility, were included as a control group. Using pippele catheter from all women collected Endometrial small biopsies at the 21st day of the cycle and immunohistochemical study for all biopsies was done. Higher CD4 and CD4/CD8 but lower CD8 levels were noticed in cases with implantation failure in comparison to controls with highly significant difference between the two groups as regards the three parameters. CD8 is more sensitive with higher predictive value (PPV) but less specific and less negative predictive value (NPV) than CD4. The best cut off value of CD4 was 4.1 while CD8 was 5.6. The sensitivity and specificity were higher when combining the two tests together with better accuracy. The prognostic value of measuring endometrial CD4 and CD8 cell parameters seems to be valuable. More studies are needed to confirm or refute the role of CD4 and CD8 assessments as a predictive test for screening in women with implantation failures who may benefit from immunotherapy.