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Integrins are proteins that are produced by the endometrium around the time of implantation. They are thought to play an important role in enabling implantation to occur.

Many studies have shown that women with fluid-filled closed tubes (closed hydrosalpinx), have half the pregnancy rate of other women with other types of tubal disease. Recently there have been two papers which have shown that removing those tubes surgically enhances the pregnancy rate with IVF. Bruce Lessey's group has shown that women with fluid-filled hydrosalpinx do not produce integrins as well as normal women. They have also shown that removing the fallopian tubes enables the uterus to produce these integrins.

There may also be other gynecological conditions that cause impaired integrin expression. Testing for integrins is now a clinically available test. It is far more useful than an endometrial biopsy alone in evaluating implantation potential. Recently there has been some focus on implantation defects in patients with endometriosis. If impaired integrin expression is present, there are several therapies (in addition to the surgery suggested above) that can be used to overcome the problem.

We do integrin testing in selected patients for whom we suspect a primary implantation defect (usually related to IVF failures). However the test is moderately expensive, poorly covered by insurance, and time consuming. In many of the situations where we suspect an implantation problem, it is more cost effective to treat for it.