Immunological Role of Intrauterine Human Chorionic Gonadotropin in Infertile Women Undergoing ICSI

BACKGROUND: Successful pregnancy is associated with a predominant Th2 cytokine profile, and Th1 cytokines are detrimental to pregnancy. The cytokine profile expressed by endometrium may be change by chorionic gonadotropin treatment (hCG), which affect uterine natural killer cell, T-regulatory, and B cells-three essential cell types for the maintenance of pregnancy-hCG has been demonstrated to have a significant immune regulatory function. It prevents expression of interferon gamma and tumor necrosis factor alpha (TNF) at mother-fetal contact. OBJECTIVE: To evaluate the role of intrauterine hCG infusion at day of ovum pickup on immunological marker of endometrium and on pregnancy rate in patients undergoing ICSI cycle. PATIENTS AND METHOD: Comparative study intended in Al-Nahrain University. Ninety infertile women included. Written informed consent was obtained before being included in the study. Three groups of patients were included according to the type of intervention. Assessment of plasma hormone level was done for all. The quantification of serum TNF and IL-10 levels was conducted through the application of the enzyme-linked immunosorbent assay methodology at a privately owned laboratory. RESULT: Significantly lower level of TNF and TNF/IL-10 ratio in group A than that in groups B and C (P < 0.05). No significant differences between study groups (P ≥ 0.05) in means IL-10. The clinical pregnancy rate was higher in group A, which is higher than in group B and C. CONCLUSION: Intrauterine infusion of 700 IU of hCG can improve the pregnancy rate in patients undergoing ICSI cycle by modulating the immune balance (Th1/Th2) of the endometrium.