**2.1. Patients**

The study was approved by local review board at West Coast IVF Clinic, Inc. and a fully informed consent was obtained from all patients. There were 21 consecutive patients between 34-50 years of age with a diagnosis of peri/postmenopause or premature ovarian failure with or without tubal disease. They underwent 24 fresh IVF cycles in this study. Controlled ovarian hyperstimulation was initiated with follitropin � (FollistimC, Crganon Pharmaceuticals, Inc.). Premature surge of endogenous gonadotropins were controlled with ganirelix acetate (AntagonC, Crganon Pharmaceuticals, Inc.). Cocyte retrieval was carried out in an office setting under local anesthesia and mild sedation. Embryo culturing was performed using sequential media (G1 and G2; Vitrolife, or Early Cleavage MediumC supplemented with SSS and Complete Multiblast MediumC with SSS; Irvine Scientific, USA) to day five or six. Up to 2 grade 1 expanded/hatching blastocysts were transferred (Fig 1A). Recipients were down regulated with long acting GnRH analog (Leuprolide acetate Depot, Abbott, USA). The endometrium was primed with Estradiol 2 mg tid until the day of donor egg retrieval, when it was continued or reduced to 1 mg tid. Luteal support was maintained with Progesterone in oil IM 50-100 mg/progesterone vaginal tablets (EndometrinC, Ferring, USA), 100 mg tid. until the day of Pregnancy test. If the test was positive progesterone was continued through the 8th week of pregnancy or sooner until a rise in serum progesterone was noted as the pregnancy progressed.

SubEndometrial Embryo Delivery (SEED) with Egg Donation – Mechanical Embryo Implantation 147

hysteroscope. The embryo(s) is deposited under direct hysteroscopic visualization (Fig 1D) using a 100 µl Hamilton syringe (Hamilton Company; Nevada, USA). No more than 2

**Figure 1.** Stages of subendometrial embryo transfer. Expanded hatching blastocyst (A); estrogenic endometrium (B); progestational endometrium (C); subendometrial embryo transfer (D); early

gestational sac at 5 weeks (E); fetus at 6 weeks (F).

embryos were implanted at any one site.

Serum human chorionic gonadotropin (hCG) was quantified on the tenth or eleventh day after SEED was performed on day six or five after retrieval, respectively. Although the assay sensitivity for detection of hCG was at 2 IU/ml a concentration of >5 IU/ml was used for confirmation of pregnancy.
