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repeated ICSI attempts are suggested in TFF [4, 170].

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fluctuations in the gamete quality are probably contributory. Pretreatment endocrine assays and semen analyses prove to be of little value in forecasting failed fertilization. One-third of the patients with TFF achieved pregnancy with their own oocytes in a subsequent ICSI cycle [10]. Since follow-up ICSI treatment has been shown to result in fertilization in 85% of cases,

Physicians should counsel patients based on the best possible evidence available and allow the couple to make an informed choice. The adverse result of a failed ICSI cycle does not imply a hopeless prognosis for future ICSI treatment. Very subtle improvements in semen parameters and/or oocyte yield/quality may result in fertilization in a subsequent ICSI attempt [169]. Otherwise, the options of donor sperm insemination, donated oocytes or embryos, adoption and remaining childless should be discussed with the couple [171].

Significant advances have been made in achieving fertilization, pregnancy and live birth in cases with severe male factor infertility, oocyte activation failure and ICSI technique. Usually fertilization is 80-100 percent in mature eggs, however, low or no fertilization can still occur. Most cases of no fertilization occur due to very low number of mature oocytes, failure of oocyte activation or non-availability of appropriate sperm. Repeated ICSI attempts

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**Chapter 6** 

© 2012 Kamrava and Yin, 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 properly cited.

© 2012 Kamrava and Yin, 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, distribution, and reproduction in any medium, provided the original work is properly cited.

**SubEndometrial Embryo Delivery (SEED) with** 

Michael Kamrava and Mei Yin

http://dx.doi.org/10.5772/50034

**1. Introduction** 

affected.

Additional information is available at the end of the chapter

**Egg Donation – Mechanical Embryo Implantation** 

Egg quality at retrieval in IVF cycles is one of the prime prognostic factors of a successful outcome in IVF cycles. Thus egg donors provide a unique opportunity for assessing the feasibility of new protocols and techniques. In these situations, where the primary reason for resorting to IVF is peri/post menopausal state of the woman, using egg donors assures that at least the quality of the eggs are optimum, and most often the sperm quality, embryo quality at transfer, the recipient's uterus and endometrial condition are not adversely

In patients undergoing *in vitro* fertilization (IVF) procedures one major set of hurdles, which often prevents healthy embryos from resulting in pregnancies, are problems associated with endometrial receptivity and implantation (1-4). From a clinical practice perspective in our new age of pre-implantation diagnosis and screening, the embryo transfer process may now be regarded as a rate limiting factor. Various techniques for embryo transfer (ET) have been advocated to increase pregnancy rates while reducing side effects from the procedure, such as lost embryos and ectopic pregnancies (5-7, 48). In addition, the advantages of using different catheters have been debated (8-11). These methods, however, use a "blind" technique of catheter introduction into the uterus. Since the embryo(s), having the zona pellucida at time of transfer, floats in the uterine cavity between one to three days from the time of transfer, the problems of "lost embryos" and the occurrence of ectopic pregnancies persist. We have hypothesized that the mechanical insertion of the blastocyst into the endometrium under direct visualization would increase the implantation and clinical pregnancy rate of IVF. The aim of this study was to re-investigate the potential of subendothelial ET, a procedure which originated from early mouse experiments (10) and in humans in the mid to late 1990's (12, 13) via trans-abdominal approaches. In contrast to these earlier investigations we propose to use hysteroscopy as a less invasive, visually confirmed, precise and reliable technique to direct and effect the implantation procedure.

