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Objective: To distinguish endocrine and paracrine influences on leukocyte subpopulations at uterine and tubal implantation sites. Design: Retrospective immunohistochemical study. Setting: Departments of Anatomy, and Obstetrics and Gynecology, School of Medicine, RWTH University of Aachen, Aachen, Germany. Patient(s): Ten women with a viable ectopic pregnancy (EP), 25 women who had undergone elective first-trimester termination of pregnancy, and 4 women who had undergone hysterectomy with adnexectomy. Intervention(s): None. Main Outcome Measure(s): Quantitative analysis of leukocyte subpopulations at the implantation sites and their corresponding noninvaded tissues, decidual tissue from patients with EP, and tubal mucosa from normal menstrual cycle. Result(s): Similar numbers and characteristic distribution patterns of macrophages, T cells, and B cells were found at both normal intrauterine and tubal implantation sites. Natural killer (NK) cells were always absent from tubal mucosa. The number and distribution of leukocytes within decidual tissue from women with EP corresponded to those in the noninvaded decidual compartment in intrauterine pregnancy (IUP). Conclusion(s): Leukocyte populations present in the tubal and uterine mucosa are an intrinsic characteristic of these tissues. The distinct leukocyte distribution pattern at the implantation sites suggests that the invading trophoblast exerts a paracrine influence on endometrial and endosalpingeal leukocytes. The absence of natural killer cells from the tubal wall may be one reason for the higher degree of invasiveness of the trophoblast at the tubal implantation site.

Objective: To compare and quantify leukocyte populations at the tubal implantation site, in the tubal mucosa away from the implantation site and in the intrauterine decidua in women who have had an ectopic tubal pregnancy with leukocyte populations in the decidualized endometrium in women who have had a normal intrauterine pregnancy. Design: Retrospective immunohistochemical study. Setting: Department of Pathology, University of Newcastle, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, United Kingdom. Patient(s): Paraffin-embedded tissue blocks from 30 women who had had an ectopic pregnancy (EP) and control tissue blocks from 19 women who had undergone elective first trimester pregnancy termination. Intervention(s): None. Main Outcome Measure(s): Quantitative analysis of defined leukocyte subpopulations in the fallopian tube (at the implantation site and in the tubal mucosa away from the implantation site) and intrauterine decidua. Result(s): Endometrial granulated lymphocytes were absent from both the tubal mucosa away from the implantation site and the tubal implantation site. T lymphocytes and macrophages formed the predominant leukocyte subpopulations in both tubal areas. In the intrauterine decidua from women who had had an EP, endometrial granulated lymphocytes were the most abundant leukocyte population and macrophages and T cells formed the second and third major leukocyte subpopulations, respectively. No differences were detected in the number or proportion of these decidual leukocytes in women who had had a normal pregnancy vs. in those who had had an EP. Conclusion(s): The absence of endometrial granulated lymphocytes from the tubal implantation site suggests that the local presence of the cells is not essential for implantation and early placental development events.

Objective To investigate the role of activin-βA subunit, activin type II receptors, inducible nitric oxide synthase (iNOS), and MUC1 in the pathogenesis of ectopic pregnancy (EP) and their involvement in the determination of the implantation site. Design Observational study. Setting Academic unit of reproductive and developmental medicine. Patient(s) Four women at the luteal phase, three pseudopregnant women at the time of hysterectomy for benign disease, and 10 archived cases of EP. We collected 14 Fallopian tubes were collected from four women at the luteal phase and three pseudopregnant women at the time of hysterectomy for benign disease; specimens from implantation site, trophoblast and remote sites from the implantation site were collected from 10 archived cases of EP. Intervention(s) Immunohistochemistry and quantitative reverse-transcriptase polymerase chain reaction (RT-PCR). Main Outcome Measure(s) Comparison of the expression of candidate molecules between the different groups. Result(s) The expression of activin-βA subunit, activin type II receptors, and iNOS was statistically significantly increased and expression of MUC1 statistically significantly decreased in tubes bearing an EP. There was no statistically significant difference in the expression of the candidate molecules between the implantation and remote sites. Candidate molecules were also expressed in the trophoblast. Conclusion(s) The pathological expression of candidate molecules by tubes bearing an EP is not involved in the determination of implantation site. Additionally, candidate molecules may play a role in the regulation of trophoblast cells in vivo during early pregnancy.

Objective To compare the mRNA expression of vascular endothelial growth factor (VEGF) and its receptors (KDR and flt-1) in the implantation and nonimplantation sites of the human oviduct with ectopic gestation. Design Prospective observational study. Setting University-based Obstetrics and Gynecology Department. Patient(s) Ten women undergoing laparoscopic salpingectomy for tubal pregnancy. Intervention(s) The mucosal layer was isolated from the implantation and nonimplantation sites of the oviduct tissue with ectopic gestation. Semiquantitative reverse transcriptase–polymerase chain reaction was performed. Main outcome measure(s) The differences in the mRNA expression of VEGF and its receptors between the implantation and nonimplantation sites of the oviduct tissue. Result(s) The mRNA expression of VEGF and its receptors, both KDR and flt-1, was significantly higher in the implantation site of the human oviduct with ectopic gestation compared with the nonimplantation site. Conclusion(s) The results suggest that VEGF may be the angiogenic factor responsible for the implantation and placentation of an ectopic pregnancy in the oviduct.

Objective To investigate the implantation site in a singleton pregnancy. Design Transvaginal ultrasonography (US) was performed at the mid or late follicular phase and/or at very early gestation before 6weeks. Setting, Patients Ultrasound monitoring was performed on 21 women with spontaneous cycles or treated by administration of 2.5mg/d bromocriptine mesylate (Parlodel; Sando Co., Tokyo, Japan) for occulted hyperprolactinemia at the Fertility Clinic of the Department of Obstetrics and Gynecology at Gunma University Hospital. Main Outcome Measures The site of the ovary with a growing follicle and/or a corpus luteum of pregnancy, and the location of a gestational sac in longitudinal and transverse views were observed. Results When ovulation occurred in the right ovary, 12 of the 14 gestational sacs were located on the right wall, 1 on the midwall, and 1 on the left wall. Ovulation in the left ovary resulted in 5 gestational sacs located in the left wall and 2 on the midwall. That is, of 21 gestational sacs, 17 were located on the ipsilateral uterine wall to the ovulating ovary, 3 on the midwall, and only 1 on the contralateral. Conclusion Implantation occurs on the ipsilateral uterine wall to the ovulating ovary.

Studies were carried out on a group of synthetic estrogens and antie strogens (clomiphene U-11555A a 23 diphenylindene derivative U-1110 0A a dihydronaphthalene and ORF-3858 2-methyl-3-ethyl-4-phenyl-delta 4-c yclohexenecarboxylic acid) to determine their effects as postcoital contraceptive agents in the rabbit and macaque monkey. Most proved effective with direct action on the implantation site in the rabbit but only ORF-3858 showed no evidence of teratogenicity and was found effective postcoitally in the primate.

Nonsurgical recovery of fertilized eggs from the vaginas of prostaglandin F2alpha (PGF2alpha)-treated rabbits was attempted. Eighty-two eggs were collected by the vaginal washing method, and the earliest egg was recovered 20 hours after mating. Twenty eggs recovered vaginally 24 to 107 hours after mating were transferred to six synchronized, pseudopregnant rabbits to test the viability of the eggs; four newborns, two fetuses, and one implantation site were obtained. These results indicate that some viable eggs are discharged into the vaginas of rabbits treated with PGF2alpha.