**3. Result**

The clinical characteristics such as age, BMI, endometrial thickness, serum estrogen and progesterone levels of women participating in this study are summarized in Table I.


(Mean ± SEM)

Table 1.

Low levels of immunoreactivity of the endometrial receptivity markers including αvβ<sup>3</sup> integrin, LIF, L-selectin ligands (MECA-79) and Muc-1 were observed in women with

Alteration in Endometrial Remodeling: A Cause for Implantation Failure in Endometriosis? 333

Further, few poorly developed pinopodes were seen in women with endometriosis as compared to controls, which showed abundant well formed pinopodes (Figure 2, 3 and 4).

Fig. 3. Poorly developed pinopodes in endometriosis

Fig. 2. Well developed pinopodes in control

endometriosis in contrast to strong immunoreactivity of controls. In addition, mean expression of these molecular markers detected by flow cytometric analysis shows a significantly lower expression both by the stromal and epithelial cells in women with endometriosis as compared to controls.

Fig. 1. Immunohistological images of different biochemical markers expression. **a**. αvβ3 integrins in control **b**. αvβ3 integrins in women with endometriosis **c**. Graphical representation of αvβ3 integrin expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **d.** LIF in control **e.** LIF in women with endometriosis **f.** Graphical representation of LIF expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **g**. L-selectin ligand in control **h**. L-selectin ligand in women with endometriosis **i**. Graphical representation of L-selectin ligand expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **j**. Muc1 in control **k**. Muc1 in women with endometriosis **l**. Graphical representation of Muc1 expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control.

Further, few poorly developed pinopodes were seen in women with endometriosis as compared to controls, which showed abundant well formed pinopodes (Figure 2, 3 and 4).

Fig. 2. Well developed pinopodes in control

332 Endometriosis - Basic Concepts and Current Research Trends

endometriosis in contrast to strong immunoreactivity of controls. In addition, mean expression of these molecular markers detected by flow cytometric analysis shows a significantly lower expression both by the stromal and epithelial cells in women with

Fig. 1. Immunohistological images of different biochemical markers expression. **a**. αvβ3 integrins in control **b**. αvβ3 integrins in women with endometriosis **c**. Graphical representation of αvβ3 integrin expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **d.** LIF in control **e.** LIF in women with endometriosis **f.** Graphical representation of LIF expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **g**. L-selectin ligand in control **h**. L-selectin ligand in women with endometriosis **i**. Graphical representation of L-selectin ligand expression in the stromal and epithelial cells of endometrial tissues in endometriosis and control **j**. Muc1 in control **k**. Muc1 in women with endometriosis **l**. Graphical representation of Muc1 expression

in the stromal and epithelial cells of endometrial tissues in endometriosis and control.

endometriosis as compared to controls.

Fig. 3. Poorly developed pinopodes in endometriosis

Alteration in Endometrial Remodeling: A Cause for Implantation Failure in Endometriosis? 335

**MMP-9**

**TIMP-1**

**Endo**

**ENDO**

Control Endo

Fig. 7. Expression of MMP-9 gene in endometriosis and control

**0**

**2**

**4**

**Relative Expression**

**6**

**Control**

**Control**

**-2**

Fig. 8. Expression of TIMP-2 gene in endometriosis and control

Fig. 9. Expression of MMP-2 and -9 in endometriosis and control

**-1**

**0**

**Relative Expression**

**1**

**2**

Fig. 4. Graphical representation of pinopode expression in the endometrial tissues in endometriosis and controls.

A significant increase in endometrial MMP-2, -9 and decrease in TIMP-1 and -2 expressions, were observed in women with endometriosis when compared to controls. Further, the endometrial expression of COX-2 was observed to be higher in women with endometriosis when compared with controls.

Fig. 5. Expression of MMP-2 gene in endometriosis and control

**TIMP-2**

Fig. 6. Expression of TIMP-2 gene in endometriosis and control

Fig. 4. Graphical representation of pinopode expression in the endometrial tissues in

A significant increase in endometrial MMP-2, -9 and decrease in TIMP-1 and -2 expressions, were observed in women with endometriosis when compared to controls. Further, the endometrial expression of COX-2 was observed to be higher in women with endometriosis

**MMP-2**

**TIMP-2**

**ENDO**

**ENDO**

endometriosis and controls.

when compared with controls.

Fig. 5. Expression of MMP-2 gene in endometriosis and control

**0**

**1**

**2**

**Relative Expression**

**3**

**CONTROL**

**0**

Fig. 6. Expression of TIMP-2 gene in endometriosis and control

**1**

**2**

**Relative Expression**

**3**

**4**

**CONTROL**

Fig. 7. Expression of MMP-9 gene in endometriosis and control

**TIMP-1**

Fig. 8. Expression of TIMP-2 gene in endometriosis and control

Fig. 9. Expression of MMP-2 and -9 in endometriosis and control

Alteration in Endometrial Remodeling: A Cause for Implantation Failure in Endometriosis? 337

**ENDO**

**CONTROL**

Fig. 13. Expression of VEGFR-1 gene in endometriosis and controls

Fig. 14. Expression of VEGFR-2 gene in endometriosis and controls

Fig. 15. Expression of endometrial VEGF in endometriotic women and control

Fig. 16. Expression of endometrial VEGFR in endometriotic women and control

**0**

**1**

**2**

**Relative Expression**

**3**

**4**

Fig. 10. Expression of TIMP-1 and -2 in endometriosis and control

Fig. 11. Expression of COX-2 gene in endometriosis and control

Fig. 12. Expression of COX-2 in endometriosis and control

Fig. 10. Expression of TIMP-1 and -2 in endometriosis and control

Fig. 11. Expression of COX-2 gene in endometriosis and control

Fig. 12. Expression of COX-2 in endometriosis and control

Fig. 13. Expression of VEGFR-1 gene in endometriosis and controls

Fig. 14. Expression of VEGFR-2 gene in endometriosis and controls

Fig. 15. Expression of endometrial VEGF in endometriotic women and control

Fig. 16. Expression of endometrial VEGFR in endometriotic women and control

Alteration in Endometrial Remodeling: A Cause for Implantation Failure in Endometriosis? 339

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**5. References** 

Endometrial expression of VEGF and its receptors VEGFR1 and VEGFR2 were observed to be lower and higher respectively in women with endometriosis when compared with controls.
