**6. References**


protein-related protein 1 as a new gene implicated in human endometrial receptivity. J Clin Endocrinol Metab 2003;88:1849-57.

[3] Jokimaa V, Cksjoki S, Kujari H, Vuorio E, Anttila L. Altered expression of genes involved in the production and degradation of endometrial extracellular matrix in patients with unexplained infertility and recurrent miscarriages. Mol Hum Reprod 2002;8:1111-6.

150 Enhancing Success of Assisted Reproduction

improve patient satisfaction.

**5. Conclusion** 

singleton pregnancy.

**Author details** 

Michael Kamrava and Mei Yin

**Acknowledgement** 

**6. References** 

*West Coast IVF Clinic, Inc., Beverly Hills, California, USA* 

Res Clin Cbstet Gynaecol 2003;17:289-307.

Likewise, visualizing implantation allows for the physician to avoid losing embryos due to intrinsic uterine contractions or those brought on by the transfer, enabling the physician to defer the procedure until the enhanced activity has subsided. Furthermore, visualization allows one to place the embryo at a different location if trauma ensues. Also, the catheter used is semi-rigid to prevent kinking as it passes through the endoscope yet with enough flexibility to bend with the endoscope however bend and become kinked to prevent inadvertent passage into the myometrium. In addition, the uterine cavity is allowed to be distended during introduction of the hysteroscope into the uterus by slow passage through the endocervical canal. This would allow the hysteroscope to move in a gaseous space and not in direct contact with the endometrium as is the case with the blind procedure. In our study, no disruption to the uterine lining or uterine bleeding occurred. Increased cost is another drawback, however utilizing a hysteroscope with an objective replicable procedure that improves results will decrease the costs from multiple failed IVF-ET attempts and

We suggest that using a hysteroscopic subendometrial embryo delivery (SEED) for transferring advanced blastocyst(s) is a reasonable and effective method of embryo transfer. It will virtually eliminate ectopic pregnancies of all locations, i.e. tubal pregnancies as well as placenta previa, cervical, and heterotopic pregnancies, from IVF. Furthermore, it would allow for a targeted objective, reliable, safe and replicable method for single embryo transfer, as new and improved techniques along with modified media for handling, culture, and selection of embryos are introduced. This would greatly alleviate the anxiety, and cost to the patient as it decreases the number of attempts at using IVF in achieving a successful

Supported by West Coast IVF Clinic, Inc. and LA IVF Lab, LLC, Beverly Hills, CA USA

[1] Sharkey AM, Smith SK. The endometrium as a cause of implantation failure. Best Pract

[2] Dominguez F, Avila S, Cervero A, Martin J, Pellicer A, Castrillo JL, Simon C. A combined approach for gene discovery identifies insulin-like growth factor-binding


[18] Lambers MJ, Dogan E, Kostelijk H, Lens JW, Schats R, Hompes PGA. Ultrasonographicguided embryo transfer does not enhance pregnancy rates compared with embryo transfer based on previous uterine length measurement. Fertil Steril. 2006; 86: 867-872.

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[33] Morrish DW, Dakour J, Li H. Life and death in the placenta: new peptides and genes regulating human syncytiotrophoblast and extravillous cytotrophoblast lineage

[34] Giudice LC. Genes associated with embryonic attachment and implantation and the

[35] Payne D. Embryo viability associated with microassisted fertilization. Baillieres Clin

[36] Kamrava, M, Yin M. Hysteroscopic Subendometrial Embryo Delivery (SEED), Mechanical Embryo Implantation. International Journal of Fertility and Sterility. Vol 4,

[37] Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. High ongoing pregnancy rates after deferred transfer through bipronuclear oocyte cryopreservation and post-thaw extended culture. Fertil Steril. 2009; 92: 1594-1599. [38] Goto S, Kadowaki T, Hashimoto H, Kokeguchi S, Shiotani M. Stimulation of endometrium embryo transfer can improve implantation and pregnancy rates for patients undergoing assisted reproductive technology for the first time with a high-

[39] Lin PY, Huang FJ, Kung FT, Wang LI, Chang SY, Lan KC. Comparison of the offspring sex ratio between fresh and vitrificationthawed blastocyst transfer. Fertil Steril. 2009; 92:

[40] Ckimura T, Kuwayama M, Segawa T, Takehara Y, Kato K, Kato C. Relations between the timing of transfer, expansion size and implantation rates in frozen thawed single

[41] Stevens J, Schoolcraft WB, Schlenker T, Wagley L, Munne S, Gardner DK. Day 3 Blastomere Biopsy Does Not Affect Subsequent Blastocyst Development or

[42] Weston G, Csianlis T, Catt J, Vollenhoven B. Blastocyst transfer does not cause a

[43] Stillman RJ, Richter KS, Banks NK, Graham JR. Elective single embryo transfer: A 6 year progressive implementation of 784 single blastocyst transfers and the influence of

[44] Sparks AE, Ryan GL, Sipe CS, Dokras AJ, Syrop CH, Van Voorhis BJ. Reducing the risk of multi-fetal gestation by implementation of a single blastocyst transfer policy. Fertil

[45] Johnson GA, Burghardt RC, Bazer FW, Spencer TE. Csteopontin: roles in implantation

[46] Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in

[47] Wilcox AJ, Weinberg CR, C'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al.

Incidence of early loss of pregnancy. N Engl J Med. 1988; 319: 189-194.

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formation and renewal. Curr Protein Pept Sci. 2001; 2:245-59.

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341.

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[20] Allahbadia G, Gandhi G, Athavale U, Merchant R, Virk SPS, Kaur K. A blind embryo transfer is a rate limiting step to successful IVF. Fertil Steril. 2002: 78 Suppl 1: S157-S158. [21] Puerto B, Creus M, Carmona F, Cívico S, Vanrell JA, Balasch J. Ultrasonography as a predictor of embryo implantation after in vitro fertilization: a controlled study. Fertil

[22] Tiras B, Polat M, Korucuoglu U, Zeyneloglu HB, Yarali H. Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril.

[23] Flisser E, Grifo JA,. Krey LC, Noyes N. Transabdominal ultrasound - assisted embryo

[24] Gergely RZ, Danzer H, Surrey M, Hill D. Maximal implantation potential (MIP) pointsuggested target for optimal embryo placement within the uterine cavity during

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[27] Kol S. Ultrasound-guided embryo transfer - a special role in patients with certain

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[29] Gergely RZ, DeUgarte CM, Danzer H, Surrey M, Hill D, DeCherney AH. Three dimensional/four dimensional ultrasound-guided embryo transfer using the maximal

[30] Pinto AB, Wright JD, Keller SL, Cdem RR, Ratts VS,. William DB. Ultrasound guided embryo transfer in selected patients undergoing IVF. Fertil Steril. 2002; 77(3): S19. [31] Abou-Setta AM, Mansour RT, Al-Inany HG, Aboulghar MM, Aboulghar MA, Serour GI. Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone? A systemic review and metaanalysis of prospective randomized trials. Fertil Steril. 2007; 88: 333-

[32] Frattarelli JL, Miller KL. The pre-cycle blind mock transfer is an inaccurate predictor of

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**Chapter 7** 

© 2012 Ghanem and Al-Boghdady, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is

distribution, and reproduction in any medium, provided the original work is properly cited.

© 2012 Ghanem and Al-Boghdady, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

properly cited.

**2. Pathophysiology of luteal phase in ART** 

**Luteal Phase Support in ART: An Update** 

Assisted reproductive techniques (ART) as defined by ICMART (international society of monitoring assisted reproduction) and WHO is all treatments or procedures that include the in vitro handling of both human oocytes and sperm or of embryos for the purpose of establishing a pregnancy. This includes, but is not limited to, in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and embryo transfer, gamete intrafallopian transfer, zygote intrafallopian transfer, tubal embryo transfer, gamete and embryo cryopreservation, oocytes and embryo donation, and gestational surrogacy. ART does not include assisted insemination (artificial insemination) using sperm from either a woman's partner or a sperm donor [1]. On the other hand the term medically assisted reproduction (MAR) is given to the wider scope involving reproductive ovarian stimulation with or

The luteal phase is defined as the period from occurrence of ovulation until the establishment of a pregnancy or the resumption of menses 2 weeks later. In the context of assisted reproduction techniques luteal phase support (LPS) is the term used to describe the

Progesterone and estrogen are required to prepare the uterus for embryo implantation and to modulate the endometrium during the early stages of pregnancy. In the normal luteal phase of a nonpregnant woman, steroid production peaks four days after ovulation and continues for one week until falling several days before the next menses. If pregnancy occurs, progesterone production is restored by human chorionic gonadotrophin (hCG) stimulation. Once the oocyte is released, the follicle collapses and the remaining granulosa cells, which have acquired receptors for luteinizing hormone (LH), rapidly undergo luteinisation under the influence of LH. The formed corpus luteum requires regular

administration of medications with the aim to support the process of implantation.

Mohamad E. Ghanem and Laila A. Al-Boghdady

without insemination and ART techniques mentioned above [1]

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/51093

**1. Introduction** 
