Endometrial TNF-α, Caspase-9, Hsp70, and LIF Expression in Hydrosalpinx: Implications for Implantation Failure

Background & Objective: Hydrosalpinx has been associated with impaired endometrial receptivity and reduced fertility. This study was conducted with aim to examine the expression of Tumour Necrosis Factor-alpha (TNF-α), caspase-9, Heat shock protein 70 (Hsp70), and Leukaemia Inhibitory Factor (LIF) in the endometrium of women with and without hydrosalpinx.Materials & Methods: This cross-sectional study was conducted between May and June 2017 across three referral hospitals. A total of 48 reproductive-aged women undergoing endometrial biopsy were enrolled and equally divided into two groups: those diagnosed with hydrosalpinx and healthy controls. Immunohistochemical staining was used to assess the expression of TNF-α, caspase-9, Hsp70, and LIF. Semi-quantitative analysis was performed using histoscore evaluation of staining intensity and distribution.Results: The hydrosalpinx group compared to the control group significantly exhibited higher expression of TNF-α (median 12 vs. 9) and caspase-9 (12 vs. 8.5), and lower expression of Hsp70 (6 vs. 8) and LIF (9 vs. 12) (P<0.001 for TNF-α, caspase-9, and Hsp70; P<0.05 for LIF, respectively).Conclusion: Hydrosalpinx is associated with altered expression of inflammatory and apoptotic markers in the endometrium, including elevated TNF-α and caspase-9 and reduced Hsp70 and LIF. These molecular disruptions may impair endometrial receptivity and contribute to infertility, highlighting potential targets for therapeutic intervention.