Many factors impede embryonic implantation, and excluding obvious known factors such as chronic endometritis, the immune status of the endometrium may be related to pregnancy. Although an abundantly large number of immune cells infiltrate the endometrium during the secretory phase, whether these immune cells can be used as a predictor of prognosis in ART has not yet been clarified. In the present study we therefore retrospectively analyzed 97 CD138-negative women with a previous fresh-embryo-transfer failure. We assessed the expression of CD56+ uNK cells, CD16 + NK cells, CD57 + NK cells, CD68+ pan-macrophages, CD163 + M2 macrophages, CD4 + T cells, CD8 + T cells, FOXP3+ regulatory T cells, and CD19 + B cells in the endometrium by IHC to evaluate mid-luteal endometrial immune cells as prognostic indicators of pregnancy outcome in the next frozen-embryo-transfer cycle. CD19-positive cells and the intraglandular CD163-positivity rate increased significantly in the clinically non-pregnant group (0.47% vs. 0.20%, P = 0.021; 61% vs. 30%, P = 0.017). The ratios of CD4/CD8 were also higher in the non-pregnant group (1.96 vs. 1.45, P = 0.005).The area under the ROC curve of CD19 cell number alone, the intraglandular CD163-positivity alone, and CD19 number combined with the intraglandular CD163-positivity were 0.692 (95% CI, 0.55–0.834), 0.661 (95% CI, 0.514–0.809), and 0.748 (95% CI, 0.614–0.882), respectively. The optimal cut-off value of CD19 was 0.464%, and the clinical pregnancy rate and live-birth rate diminished significantly when the CD19 level was above this cut-off value. Our study suggests that CD19-positive cells and intraglandular CD163-positivity can be used as prognostic indicators of pregnancy outcome in CD138-negative patients who experienced first-fresh-embryo transfer failure.

阻碍胚胎着床的因素很多，排除慢性子宫内膜炎等明显的已知因素，子宫内膜的免疫状态可能与妊娠有关。尽管大量免疫细胞在分泌期浸润子宫内膜，但这些免疫细胞是否可用作 ART 预后的预测因子尚未明确。因此，在本研究中，我们回顾性分析了 97 名 CD138 阴性女性，这些女性既往新鲜胚胎移植失败。我们评估了 CD56 + uNK 细胞、CD16 + NK 细胞、CD57 + NK 细胞、CD68 + 泛巨噬细胞、CD163 + M2 巨噬细胞、CD4 + T 细胞、CD8 + T 细胞、FOXP3 + 调节性 T 细胞、通过 IHC 检测子宫内膜中的 CD19 + B 细胞，以评估黄体中部子宫内膜免疫细胞作为下一个冷冻胚胎移植周期中妊娠结局的预后指标。临床非妊娠组 CD19 阳性细胞和腺内 CD163 阳性率显着增加（0.47% vs. 0.20%，P  = 0.021；61% 与 30%，P  = 0.017）。非妊娠组的 CD4/CD8 比率也较高（1.96 对 1.45，P = 0.005）。单独 CD19 细胞数、单独腺内 CD163 阳性和 CD19 数与腺内 CD163 阳性相结合的 ROC 曲线下面积分别为 0.692（95% CI，0.55-0.834）、0.661（95% CI , 0.514–0.809) 和 0.748 (95% CI, 0.614–0.882)。CD19的最佳临界值为0.464%，当CD19水平高于该临界值时，临床妊娠率和活产率显着下降。我们的研究表明，CD19 阳性细胞和腺内 CD163 阳性可用作首次新鲜胚胎移植失败的 CD138 阴性患者妊娠结局的预后指标。