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7262019 Referat Ivf and endometrial receptivity
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REFERAT
ENDOMETRIAL RECEPTIVITY AND IVF SUCCESS RATES
Supervised by
dr Arie Adriaus Pi$ Sp O$ ampFER$ DMAS (amp)
Preseed by
Lydia Agustina 2014061008
William Djauhari 2014061050
DEPARTMENT OF O+STETRICS AND YNAECOLOY
ATMA AYA UNIVERSITY OF INDONESIA
FACULTY OF MEDICINE
- Mar0 1 -2 May -34
0
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FORE5ORD
First of all ould li to than od for only $y is graamp and is $lssings
r a$l to finish this ar ntitld (Ederia reepiviy ad IVF) hiamph is on of th assignmnts in th Dartmnt of $sttriamps and ynaampology Atma +aya ni-rsity
Faampulty of diampin W ould also li to than our sur-isor dr Ari Adrianus olim
F3 D A ho ro-idd insight and 7rtis gratly that hld and
suortd us during th maing of this ar h ampomltion of this ar ampould ha- n-r
$n aampampomlishd ithout suort and nampouragmnts from our dar familis ampollagus
and othr artis that ampould not $ mntiond on $y on
W ho this ar ampould gi- usful information for th radrs a$out o$sity in
rlation ith frtility sampially for halth ampar rofssionals W rali9 this ar is far
from rfampt and has s-ral limitations thrfor aologi9 for any mistas
nampountrd W ar hoing for futur suggstions and ampritiamps to hl imro- this ar in
th futur $ing
+aarta Aril 6th2016
Authors
i
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CONTENTS
FORE5ORD i
CONTENTS iiC6APTER I INTRODUCTION
C6APTER II LITERATURE REVIE5-
21 Anatomy of th 3ndomtrium
22 n ltitro Frtili9ation6
221 Dfinition6
222 ndiampation6
2 3ndomtrial ampti-ity and ltF=
21 3ndomtrial ampti-ity=211 3m$ryonal mlantation=
212 mlantation riod8
22 gtontrolld -arian yrstimulation and th maampt on
trin Lining
2 h iomollampular ols in 3ndomtrial ampti-ity
21 ol of omo$o7 ns in mlantation and
3ndomtrial ampti-ity
22 ntgrin and 3ndomtrial ampti-ity10
2 3ndomtrial AntiAdhsion olampuls11
24 3ndomtrial gtytoins1125 3ndomtrial roth Faamptors12
24 3ndomtrial assssmnt12
241 3ndomtrial hiampnss12
242 3ndomtrial ltolum1
24 3ndomtrial attrn14
244 3ndomtrial lood Flo15
25 3ndomtrial rampti-ity managmnt16
24 saramph on 3ndomtrial ampti-ity Faamptors and ltF uampampss
ats18
C6APTER III CONCLUSION--
REFERENCES-7
ii
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iii
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C6APTER I
INTRODUCTION
+a89rud
nfrtility is dfind as th ina$ility to amponampi- aftr 1 yar of unrotamptd
intrampours of rasona$l frunampy it is a ampommon ampondition affampting aro7imatly
10B C 15B of rroduampti-agd ampouls f not -n ithout tratmnt
aro7imatly half of omn ill amponampi- in th sampond yar of attmting $ut thr
ar still =B of ampoul ho ill faild to amponampi- aftr 2 yars of attmting and this
ill affampt th lif of th ampoul along ith th family45
Aampampording to systmatiamp halth sur-y of infrtility r-alnamp from 10 to
2010 th l-l of infrtility in 2010 r similar to thos in 10 in most orld
rgions and -n though th r-alnamp of infrtility is $li-d to ha- rmaind
rlati-ly sta$l during th ast 40 yars th dmand for infrtility -aluation and
tratmnt has inamprasd n ndonsia infrtility affampts around 12B or as muamph as
million ampouls ith 80B of rimary infrtility and 20B of sampondary infrtility ith
15B C 0B of it is un7laind46=
ratmnt of un7laind infrtility inampluds intrautrin insmination suro-ulation and assistd rroduampti- tamphnologis A h trm A
dsampri$s ampliniampal and la$oratory tamphnius usd to aamphi- rgnanampy in infrtil
ampouls of un7laind tiologis n -itro frtili9ation ltF is on of A
tamphnius hiamph ha- th highst rgnanampy rat in th nitd tats thr is at
last 180100 dli-ry amponampi-d from an ltF Dsit rampnt ad-anamps in ltF
tamphnius th rgnanampy rat has not inampras aampampordingly and imlantation rats r
m$ryo transfrrd -ary in studis $ut rmain at a lo 10B C 15 B or 86B C
462B248
h 2 most imortant rognostiamp faamptor for ltF suampampss or imlantation in
gnral ar normal and funamptional m$ryo at th $lastoampyst d-lomntal stag and
ndomtrial rampti-ity 3ndomtrial rampti-ity aramtrs ar ndomtrial thiampnss
attrn -olum $lood flo artial ndoamprin amphang samprtion of groth faamptors and
so on hr ar diffrnt ays to -aluat all of ths aramtrs som of hiamph ampan
$ asily -aluat $y an ultrasonograhy masurmnts or histologiampal
immunoassay thos ar ndomtrial thiampnss $lood flo and samprtion of groth
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
2
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
4
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
=
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
8
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
10
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
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miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
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ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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FORE5ORD
First of all ould li to than od for only $y is graamp and is $lssings
r a$l to finish this ar ntitld (Ederia reepiviy ad IVF) hiamph is on of th assignmnts in th Dartmnt of $sttriamps and ynaampology Atma +aya ni-rsity
Faampulty of diampin W ould also li to than our sur-isor dr Ari Adrianus olim
F3 D A ho ro-idd insight and 7rtis gratly that hld and
suortd us during th maing of this ar h ampomltion of this ar ampould ha- n-r
$n aampampomlishd ithout suort and nampouragmnts from our dar familis ampollagus
and othr artis that ampould not $ mntiond on $y on
W ho this ar ampould gi- usful information for th radrs a$out o$sity in
rlation ith frtility sampially for halth ampar rofssionals W rali9 this ar is far
from rfampt and has s-ral limitations thrfor aologi9 for any mistas
nampountrd W ar hoing for futur suggstions and ampritiamps to hl imro- this ar in
th futur $ing
+aarta Aril 6th2016
Authors
i
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CONTENTS
FORE5ORD i
CONTENTS iiC6APTER I INTRODUCTION
C6APTER II LITERATURE REVIE5-
21 Anatomy of th 3ndomtrium
22 n ltitro Frtili9ation6
221 Dfinition6
222 ndiampation6
2 3ndomtrial ampti-ity and ltF=
21 3ndomtrial ampti-ity=211 3m$ryonal mlantation=
212 mlantation riod8
22 gtontrolld -arian yrstimulation and th maampt on
trin Lining
2 h iomollampular ols in 3ndomtrial ampti-ity
21 ol of omo$o7 ns in mlantation and
3ndomtrial ampti-ity
22 ntgrin and 3ndomtrial ampti-ity10
2 3ndomtrial AntiAdhsion olampuls11
24 3ndomtrial gtytoins1125 3ndomtrial roth Faamptors12
24 3ndomtrial assssmnt12
241 3ndomtrial hiampnss12
242 3ndomtrial ltolum1
24 3ndomtrial attrn14
244 3ndomtrial lood Flo15
25 3ndomtrial rampti-ity managmnt16
24 saramph on 3ndomtrial ampti-ity Faamptors and ltF uampampss
ats18
C6APTER III CONCLUSION--
REFERENCES-7
ii
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iii
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C6APTER I
INTRODUCTION
+a89rud
nfrtility is dfind as th ina$ility to amponampi- aftr 1 yar of unrotamptd
intrampours of rasona$l frunampy it is a ampommon ampondition affampting aro7imatly
10B C 15B of rroduampti-agd ampouls f not -n ithout tratmnt
aro7imatly half of omn ill amponampi- in th sampond yar of attmting $ut thr
ar still =B of ampoul ho ill faild to amponampi- aftr 2 yars of attmting and this
ill affampt th lif of th ampoul along ith th family45
Aampampording to systmatiamp halth sur-y of infrtility r-alnamp from 10 to
2010 th l-l of infrtility in 2010 r similar to thos in 10 in most orld
rgions and -n though th r-alnamp of infrtility is $li-d to ha- rmaind
rlati-ly sta$l during th ast 40 yars th dmand for infrtility -aluation and
tratmnt has inamprasd n ndonsia infrtility affampts around 12B or as muamph as
million ampouls ith 80B of rimary infrtility and 20B of sampondary infrtility ith
15B C 0B of it is un7laind46=
ratmnt of un7laind infrtility inampluds intrautrin insmination suro-ulation and assistd rroduampti- tamphnologis A h trm A
dsampri$s ampliniampal and la$oratory tamphnius usd to aamphi- rgnanampy in infrtil
ampouls of un7laind tiologis n -itro frtili9ation ltF is on of A
tamphnius hiamph ha- th highst rgnanampy rat in th nitd tats thr is at
last 180100 dli-ry amponampi-d from an ltF Dsit rampnt ad-anamps in ltF
tamphnius th rgnanampy rat has not inampras aampampordingly and imlantation rats r
m$ryo transfrrd -ary in studis $ut rmain at a lo 10B C 15 B or 86B C
462B248
h 2 most imortant rognostiamp faamptor for ltF suampampss or imlantation in
gnral ar normal and funamptional m$ryo at th $lastoampyst d-lomntal stag and
ndomtrial rampti-ity 3ndomtrial rampti-ity aramtrs ar ndomtrial thiampnss
attrn -olum $lood flo artial ndoamprin amphang samprtion of groth faamptors and
so on hr ar diffrnt ays to -aluat all of ths aramtrs som of hiamph ampan
$ asily -aluat $y an ultrasonograhy masurmnts or histologiampal
immunoassay thos ar ndomtrial thiampnss $lood flo and samprtion of groth
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
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rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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CONTENTS
FORE5ORD i
CONTENTS iiC6APTER I INTRODUCTION
C6APTER II LITERATURE REVIE5-
21 Anatomy of th 3ndomtrium
22 n ltitro Frtili9ation6
221 Dfinition6
222 ndiampation6
2 3ndomtrial ampti-ity and ltF=
21 3ndomtrial ampti-ity=211 3m$ryonal mlantation=
212 mlantation riod8
22 gtontrolld -arian yrstimulation and th maampt on
trin Lining
2 h iomollampular ols in 3ndomtrial ampti-ity
21 ol of omo$o7 ns in mlantation and
3ndomtrial ampti-ity
22 ntgrin and 3ndomtrial ampti-ity10
2 3ndomtrial AntiAdhsion olampuls11
24 3ndomtrial gtytoins1125 3ndomtrial roth Faamptors12
24 3ndomtrial assssmnt12
241 3ndomtrial hiampnss12
242 3ndomtrial ltolum1
24 3ndomtrial attrn14
244 3ndomtrial lood Flo15
25 3ndomtrial rampti-ity managmnt16
24 saramph on 3ndomtrial ampti-ity Faamptors and ltF uampampss
ats18
C6APTER III CONCLUSION--
REFERENCES-7
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C6APTER I
INTRODUCTION
+a89rud
nfrtility is dfind as th ina$ility to amponampi- aftr 1 yar of unrotamptd
intrampours of rasona$l frunampy it is a ampommon ampondition affampting aro7imatly
10B C 15B of rroduampti-agd ampouls f not -n ithout tratmnt
aro7imatly half of omn ill amponampi- in th sampond yar of attmting $ut thr
ar still =B of ampoul ho ill faild to amponampi- aftr 2 yars of attmting and this
ill affampt th lif of th ampoul along ith th family45
Aampampording to systmatiamp halth sur-y of infrtility r-alnamp from 10 to
2010 th l-l of infrtility in 2010 r similar to thos in 10 in most orld
rgions and -n though th r-alnamp of infrtility is $li-d to ha- rmaind
rlati-ly sta$l during th ast 40 yars th dmand for infrtility -aluation and
tratmnt has inamprasd n ndonsia infrtility affampts around 12B or as muamph as
million ampouls ith 80B of rimary infrtility and 20B of sampondary infrtility ith
15B C 0B of it is un7laind46=
ratmnt of un7laind infrtility inampluds intrautrin insmination suro-ulation and assistd rroduampti- tamphnologis A h trm A
dsampri$s ampliniampal and la$oratory tamphnius usd to aamphi- rgnanampy in infrtil
ampouls of un7laind tiologis n -itro frtili9ation ltF is on of A
tamphnius hiamph ha- th highst rgnanampy rat in th nitd tats thr is at
last 180100 dli-ry amponampi-d from an ltF Dsit rampnt ad-anamps in ltF
tamphnius th rgnanampy rat has not inampras aampampordingly and imlantation rats r
m$ryo transfrrd -ary in studis $ut rmain at a lo 10B C 15 B or 86B C
462B248
h 2 most imortant rognostiamp faamptor for ltF suampampss or imlantation in
gnral ar normal and funamptional m$ryo at th $lastoampyst d-lomntal stag and
ndomtrial rampti-ity 3ndomtrial rampti-ity aramtrs ar ndomtrial thiampnss
attrn -olum $lood flo artial ndoamprin amphang samprtion of groth faamptors and
so on hr ar diffrnt ays to -aluat all of ths aramtrs som of hiamph ampan
$ asily -aluat $y an ultrasonograhy masurmnts or histologiampal
immunoassay thos ar ndomtrial thiampnss $lood flo and samprtion of groth
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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iii
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C6APTER I
INTRODUCTION
+a89rud
nfrtility is dfind as th ina$ility to amponampi- aftr 1 yar of unrotamptd
intrampours of rasona$l frunampy it is a ampommon ampondition affampting aro7imatly
10B C 15B of rroduampti-agd ampouls f not -n ithout tratmnt
aro7imatly half of omn ill amponampi- in th sampond yar of attmting $ut thr
ar still =B of ampoul ho ill faild to amponampi- aftr 2 yars of attmting and this
ill affampt th lif of th ampoul along ith th family45
Aampampording to systmatiamp halth sur-y of infrtility r-alnamp from 10 to
2010 th l-l of infrtility in 2010 r similar to thos in 10 in most orld
rgions and -n though th r-alnamp of infrtility is $li-d to ha- rmaind
rlati-ly sta$l during th ast 40 yars th dmand for infrtility -aluation and
tratmnt has inamprasd n ndonsia infrtility affampts around 12B or as muamph as
million ampouls ith 80B of rimary infrtility and 20B of sampondary infrtility ith
15B C 0B of it is un7laind46=
ratmnt of un7laind infrtility inampluds intrautrin insmination suro-ulation and assistd rroduampti- tamphnologis A h trm A
dsampri$s ampliniampal and la$oratory tamphnius usd to aamphi- rgnanampy in infrtil
ampouls of un7laind tiologis n -itro frtili9ation ltF is on of A
tamphnius hiamph ha- th highst rgnanampy rat in th nitd tats thr is at
last 180100 dli-ry amponampi-d from an ltF Dsit rampnt ad-anamps in ltF
tamphnius th rgnanampy rat has not inampras aampampordingly and imlantation rats r
m$ryo transfrrd -ary in studis $ut rmain at a lo 10B C 15 B or 86B C
462B248
h 2 most imortant rognostiamp faamptor for ltF suampampss or imlantation in
gnral ar normal and funamptional m$ryo at th $lastoampyst d-lomntal stag and
ndomtrial rampti-ity 3ndomtrial rampti-ity aramtrs ar ndomtrial thiampnss
attrn -olum $lood flo artial ndoamprin amphang samprtion of groth faamptors and
so on hr ar diffrnt ays to -aluat all of ths aramtrs som of hiamph ampan
$ asily -aluat $y an ultrasonograhy masurmnts or histologiampal
immunoassay thos ar ndomtrial thiampnss $lood flo and samprtion of groth
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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C6APTER I
INTRODUCTION
+a89rud
nfrtility is dfind as th ina$ility to amponampi- aftr 1 yar of unrotamptd
intrampours of rasona$l frunampy it is a ampommon ampondition affampting aro7imatly
10B C 15B of rroduampti-agd ampouls f not -n ithout tratmnt
aro7imatly half of omn ill amponampi- in th sampond yar of attmting $ut thr
ar still =B of ampoul ho ill faild to amponampi- aftr 2 yars of attmting and this
ill affampt th lif of th ampoul along ith th family45
Aampampording to systmatiamp halth sur-y of infrtility r-alnamp from 10 to
2010 th l-l of infrtility in 2010 r similar to thos in 10 in most orld
rgions and -n though th r-alnamp of infrtility is $li-d to ha- rmaind
rlati-ly sta$l during th ast 40 yars th dmand for infrtility -aluation and
tratmnt has inamprasd n ndonsia infrtility affampts around 12B or as muamph as
million ampouls ith 80B of rimary infrtility and 20B of sampondary infrtility ith
15B C 0B of it is un7laind46=
ratmnt of un7laind infrtility inampluds intrautrin insmination suro-ulation and assistd rroduampti- tamphnologis A h trm A
dsampri$s ampliniampal and la$oratory tamphnius usd to aamphi- rgnanampy in infrtil
ampouls of un7laind tiologis n -itro frtili9ation ltF is on of A
tamphnius hiamph ha- th highst rgnanampy rat in th nitd tats thr is at
last 180100 dli-ry amponampi-d from an ltF Dsit rampnt ad-anamps in ltF
tamphnius th rgnanampy rat has not inampras aampampordingly and imlantation rats r
m$ryo transfrrd -ary in studis $ut rmain at a lo 10B C 15 B or 86B C
462B248
h 2 most imortant rognostiamp faamptor for ltF suampampss or imlantation in
gnral ar normal and funamptional m$ryo at th $lastoampyst d-lomntal stag and
ndomtrial rampti-ity 3ndomtrial rampti-ity aramtrs ar ndomtrial thiampnss
attrn -olum $lood flo artial ndoamprin amphang samprtion of groth faamptors and
so on hr ar diffrnt ays to -aluat all of ths aramtrs som of hiamph ampan
$ asily -aluat $y an ultrasonograhy masurmnts or histologiampal
immunoassay thos ar ndomtrial thiampnss $lood flo and samprtion of groth
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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faamptors n of ndomtrial rampti-ity aramtrs that ampan $ -aluatd using an
is ndomtrial thiampnss and ith a dolr ultrasound th $lood flo or
-asampulari9ation of th ndomtrial all ampan also $ -aluatd roth faamptor in th
ndomtrium amponsists of -asampular ndothlial groth faamptor lt3F induampd $y th
strogn to induamp angiognsis and ampan $ -aluatd using a histologiampal
immunoassay that is th rimary anti-asampular ndothlial groth faamptor anti$ody
antilt3F a$=gtat983214=10
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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C6APTER II
LITERATURE REVIE5
21 Aay Ederiu
3ndomtrium is th innr muampous lining of th utrus t amponsists of lamina
roria and surfaamp h surfaamp ithlium is a singl layr of ampiliatd ampolumnar
ithlium And th lamina roria ampontains stromal amplls ndomtrial glands -ssls
and nr-s h glands ar siml tu$ular and lind $y muampus samprting nonampiliatd
ampolumnar ithlium hiamph ntrat th stroma and somtims -n ntr th musampl
ampoat h ndomtrium ampoats th ntir innr surfaamp of th utrus and amphangd in
thiampnss along ith o-um groth in th o-aris in th mnstrual ampyampl it also
amphangs to dampidua during rgnanampy During mnstruation most art of th
ndomtrium is rlasd and thn rolifrat along ith th maturation of folliampl in
th o-aris follod $y th samprtory has aftr o-ulation hs ampyampls ampan $
idntifid $y th $iosy of th ndomtrium2
3ndomtrium ampan $ di-idd into 2 layrs funamptionalis layr hiamph loampatd
surfiampially shd and rgnratd from th dr $asalis layr h diffrnamps
$tn ths 2 layrs amponsists in th amphang of artriols that gi- $lood to th
ndomtrium h ithlia in th funamptionalis layr shos an aampti- rolifration
aftr mntruation until th isod of o-ulation itEs ampalld th rolifration ampyampl and
follod $y th samprtory ampyampl hiamph amponsists of aampti- samprtion $y th ndomtrial
glands hs ampyampls ar affamptd $y hormons ampontri$uting in th mnstrual ampyampl
h $asalis layr of ndomtrium is a strong tissu $ut is ampoild for th d-lomnt
of th siral artry h hass of ndomtrial all amphangs in mnstrual ampyampl ar
rolifrati- samprtoriamp and mntruation2
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
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Figur 2 lationshi of mnstrual ampyampl and ndromtial all thiampnss
gthangs of strogn and rogstron hormon amponampntration affampts th
ndomtrial all 3ithlial C glandular amplls stromal C msnamphymal amplls and $lood
-ssls of th ndomtrium rliampat ampyampliampally in rroduampti-agd oman at a raidrat Along ith th folliampular has stradiol roduamption is th most imortant faamptor
in ndomtrial rampo-ry folloing mnstruation y th fifth day of ndomtrial ampyampl
C fifth day of mnstruation th ithlial surfaamp of th ndomtrium has $n
rstord and r-asampulari9ation is in rogrss h ro-ulatory ndomtrium is
ampharaamptri9d $y rolifration of glandular stromal and -asampular ndothlial amplls n
th arly rolifrati- has th ndomtrial all is 2 mm thiamp th glands ar
narro tu$ular struampturs that ursu almost a straight aralll ampours from th $alais
layr toard th ndomtrial ampa-ity itotiamp figurs sampially in th glandular
ithlium ar idntifid $y th fifth ampyampl day hr th mitotiamp aampti-ity of
ithlium and stroma rsists until day 16 or 1= or 2 to days aftr o-ulation
ithli9ation and angiognsis ar imortant to ndomtrial $lding ampssation
ths ar dndnt on tissu groth hiamph is strogn rgulatd 3ithlial ampll
groth is also rgulatd in art $y idrmal groth faamptor 3F and transforming
groth faamptor αFα 3strogn also induamp stromal ampll rolifration loampal l-l of
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
=
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
10
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
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6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
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alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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fi$ro$last groth faamptor and lt3F hiamph ampauss angiognsis through -ssl
longation in th $asalis
Figr 24 3ndomtrial amphangs in rgnanampy
y th lat rolifrati- has th ndomtrium thiampns from $oth glanduar
hyrlasia and inamprasd stromal ground su$stanamp h loos stroma is sampially
rominnt and th glands in th funamptionalis layr ar idly sratd his is
ampomard ith thos of th $asalis layr in hiamph th glands ar mor amprodd and
th stroma is dnsr At midampyampl as o-ulation nars glandular ithlium $ampoms
tallr and sudostratifid h surfaamp ithlial amplls aampuir numrous miampro-illi
hiamph inampras ithlial surfaamp ara and ampilia hiamph aid in th mo-mnt of
ndomtrial samprtion during th samprtory has
During th arly samprtory has aftr o-ulation th strognrimd
ndomtrium rsonds to rising rogstron l-ls y day 1= glyampogn
aampampumulats in th $asal ortion of glandular ithlium amprating su$nuamplar -aampuols
and sudostratifiampation hiamph is th first sign of o-ulation n day 18 -aampuols
mo- to th aiampal ortion of th samprtory nonampiliatd amplls y day 1 ths amplls
$gin to samprt glyamporotin and muampoolysaampampharid ampontnts into th lumn h
mitotiamp aampti-ity is ampasd $y samprtory aampti-ity du to rising rogstron l-ls hiamph
antagoni9 th mitotiamp ffampts of rogstron n days 21 to 24 th stroma $ampoms
dmatous n days 22 to 25 stromal amplls sorrounding th siral artriols $gin to
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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nlarg and stromal mitosis $ampoms aarnt Days 2 to 28 ar ampharaamptri9d $y
rdampidual amplls hiamph surround siral artriols An imortant fatur of samprtory
has ndomtrium $tn days 22 and 25 is striing amphangs assoampiatd ith
rddiampual transformation of th ur to thirds of th funamptionalis layr h
glands 7hi$it 7tnsi- ampoiling and luminal samprtion $ampom -isi$l amprtoriamp
has is also highlightd $y th ampontinuing groth and d-lomnt of th siral
artris hiamph $ampoms siral and ampoild orhologiampal and funamptional rortis of
siral artris ar uniu and ssntial for sta$lishing $lood flo amphangs to rmit
ithr mnstruation or imlantation During ndomtrial groth siral artris
lngthn at a rat arampia$ly gratr than th rat of ndomtrial thiampning hiamph
induamps gratr ampoiling of th alrady siraling -ssls
-- I Vir Feriiai
-- Deiii
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom
infrtility and roduamp a rgnanampy as a dirampt rsult of th intr-ntion n gnral
th o-aris ar stimulatd $y a ampom$ination of frtility mdiampations and thn on or
mor ooampyts ar asiratd from o-arian folliampls hs ar frtili9d in th
la$oratory Gin -itroG aftr hiamph on or mor m$ryos ar transfrrd into th
utrin ampa-ity hs sts oampampur o-r a$out a to intr-al of tim hiamph is
ampalld an ltF ampyampl11
--- Idiai
ndiampations of ltF ar1
bull u$al disas
bull n7laind infrtility
bull 3ndomtriosisbull al faamptor infrtility
bull ultil faamptors fmal and mal
bull Faild o-ulation induamption
bull -arian failur
bull Woman ith normal o-aris $ut no funamptional untrus
bull Womn ith gntiamp ris
-7 Ederia reepiviy ad IVF
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
=
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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rognostiamp faamptor of ltF suampampss rat dnds on a f faamptor to of th most
imortant faamptors ar m$ryo uality and utrin rampti-ity nfortunatly mthods
to dtrmin m$ryo halth ar imrfampt thrfor to ma7imi9 th ro$a$ility of
rgnanampy mor than on m$ryo is tyiampally transfrrd and rsulting in inamprasd
ris of multiftal gstation For ndomtrial rampti-ity thr ar a f aramtrs
a$l to gi- a $ttr amphanamp for $lastoampyst imlantation inampluding ndomtrial
thiampnss $lood flo and samprtion of groth hormon
-7 Ederia reepiviy
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of
th ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali- 14
3ndomtrial rampti-ity is dfind as a tmorary uniu sunamp of faamptors that
ma ndomtriaum rampti- to th m$ryioniamp imlantation
-7 Ebryi ipaai
3m$ryoniamp imlantation is th rsult of a lloramphstratd sunamp
of -nts inampluding ampllular adhsion in-asion immun rgulatory
mamphanism som of hiamph ar ampontrolld through gntiamp roampsss $y h
o-arian hormons ost days of th mnstrual ampyampl th ndomtrium is
ssntially hostil toards h m$ryo A major hysiologiampal nda-our is
thus ndd $y th ndomtrium to r-rs this ampondition
h rising strogn l-l during th first art of mnstrual ampyampl
nhanamps ndomtrial ampll rolifration Folloing o-ulation rogstron
l-ls samprtd $y th lutin9d folliampls lad to th diffrntiation of ths
amplls At ths oints ndomtrium is matur and rimd for m$ryo
imlantation Whn th $lastoampyst ntrs through on of Falloian ostia 4
days aftr o-ulation it aars to mo- frly in th utrin ampa-ity lamptins
r roosd to ha- an imortant rol in this has to nsur suita$l
rolling of th $lastoampyst lamptin nsur that th $lastoampyst ill -ntually
sttl in th ror sot and amporrampt th orintation o r-nt th $lastoampyst
from adhring to an ara ith oor amphanamps of imlantation an imortant
rol is layd $y th rllnt aampti-ity of gt1 n artiampular aras
samprtion of amphmoins and groth faamptors ill attraampt th $lastoampsyt to
landing latforms non as inods hs inoods ar fully d-lod for
=
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
8
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
10
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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only 1 ir 2 days and 7tn o-r th tis of th miampro-illi 7rssing th
rllnt gt1 At this stag adhsion molampuls suamph as intgrins and
ampadhrins intr-n to nsur adhsi-s $tn m$ryo and th
ndomtrium2
Figur 25 uman m$ryoniamp imlantation
-7- Ipaai perid
h ndomtrium is normally a nonrampti- n-ironmnt for an
am$ryo 7ampt during imlantation indo mlantation indo is a
riod during hiamph th ndomtrium is otimally rampti- to imlanting
$lastoampyst mlantation of th human m$ryo may oampampur only during
rgulatd imlantation indo on days 610 osto-ulation and surroundd
$y rfraamptory ndomtrial status t may $ ossi$l to artifiampially idn th
imlantation indo $y maniulating th r and ri imlantation
ndoamprin n-ironmnt
For otimal rsults in ltF it is ampritiampal to rampogni9 yh tim for
m$ryonal transfr that uld $st amporrsonds ith th imlantation
indo 3m$ryo transfr data from assistdamponamption ampyampls suggst a
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
7262019 Referat Ivf and endometrial receptivity
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
14
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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indo lasting aro7imatly 4 days from days 2024 of th ampyampl ost
rampntly ha- turnd to rlating th ndo of imlantation to th L
surg h indo oampampurs $tn LH= and LH1124
-7- Cred varia 0ypersiuai ad 0e ipa uerie ii9
n ordr to sta$lish an ndomtrium that is a$l to offr th
$lastoampyst a sit for attaamphmnt and nourishmnt it has to undrgo amprtain
rolifrati- amphangs t has $n shon that ampontrolld o-arian
hyrstimulaion has a grat imaampt on utrin lining gthangs to th
ndomtrium oampampur as an ansr to hormonal signals During natural ampyampls
ths signals ar stradiol and rogstron $ut in assistd ampyampls ths
hormons ar su$stitutd $y ampontrolld o-arian hyrstimulation gtusing gonadotroins in -arious diffrnt rotoampols in ordr to induamp multil
folliampular groth his may lad to diffring hormon l-ls to thos in
natural ampyampls and may otntially altr ndomtrial d-lomnt and
rampti-ity ampntly ths stimulation rotoampols amponsist mostly of ithr
h or rampom$inant F injamptions alon or if th srum stradiol l-ls
ar initially too lo and furthr stimulation of folliampular groth is ndd a
ampom$ination of $oth15
3strogn and rogstron ha- dirampt imaampt on th utrin lining
h surahysiologiamp stradiol l-l during gt may ha- a dtrimntal
ffampt on ndomtrial rampti-ity 37ampssi- strogn administrd
osto-ulation ampan r-nt imlantation t as found that signifiampantly mor
-ia$l rgnanampis oampampurrd among atints ith an strogn to rogstron
ratio in th rang of =6 to 1222 ampalampulatd as strogn in molIL di-idd
$y rogstron in nmolIL
-77 T0e bieuar res i ederia reepiviy
-77 Re 0eblt 9ees i ipaai ad ederia reepiviy
J gns ar ssntial for ndomtrial groth diffrntiation and
rampti-ity $y mdiating som funamptions of th s7 stroids during aamph
rroduampti- ampyampl oth JA10 and J11 mKA ar 7rssd in
hman ndomtrial ithlial and stromal amplls and thir 7rssion is
signifiampantly highr in th mid and lat samprtory hass ampoinampiding ith
him of m$ryo imlantation and high l-ls of strogn and rogstron
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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oro-r in th ampas of suampampssful imlantation th dampiduas of th arly
rgnanampy ampontinus to 7rss high l-ls of JA10 and JA11
oth strogn and rogstron aampt indndntly and in amponamprt to
urgulat JA10 and JA11 7rssion in ndomtrium25
JA 10 7rssion in th human ndomtrium shod a a
during th imlantation indo suggsting a rol for this gn roduampt in
imlantation JA 10 is no a ampharaamptri9d molampular marr of
ndomtrial rampti-ity hiamph 7rts liotroiamp ffampts on multil asampts
of adult ndomtrial d-lomnt inampluding stromal dampiduali9ation
luoampyt infiltration and inood d-lomnt
h liotroiamp ffampts of JA 10 on ndomtrial diffrntiation
and funamption ar lily modulatd through th rgulation of a num$r of
donstram targt gns that ar nampssary for th imlantation roampss
hs inamplud mty siraampls homolog 3J2 insulinli groth faamptor
$inding rotin1 F1 and intgrin $ 3J2 and F1
ar donrgulatd $y JA10 hil is urgulatd $y JA
10 3J2 is a ngati- transampritional targt of JA10 in th
roroduampti- and its donrgulation is ssntial for normal ndomtrium
d-lomnt in th tim lading u to $lastoampyst imlantation 1 is
7rssd $y human dampiduali9d ndomtrial stroma amplls hr it may aampt
as a ngati- faamptor in m$ryogniamp imlantation and is in-ol-d in
dampiduali9ation and JA10 ngati-ly influnamps F1 7rssion
aampts as a $ridging molampul $tn th ndomtrium and
troho$last amponstituting an arly hysiampal lin $tn th matrnal and
ftal tissu2
-77- Ie9ri ad ederia reepiviy
ntgrins ar a family of transmm$ran glyamporotins formd $y th
assoampiation of to diffrnt nonampo-alntly lind and M su$unit h
su$units ampontain 7traampllular transmm$ranal and intraampllular domains
h 7tra7llular domain na$ls intgrins to aampt as a ramptor to
7traampllular matris ampomonnts fi$ronamptin laminin and ampollagn ty lt
ampomlmnt and othr amplls h intraampllular domain is a$l to intraampt ith
th ampytoslton ntgrins artiampiat in ampllmatri7 and ampllampll adhsion
A larg -arity if intgrins ha- $n dsampri$d ithin th luminal
and glandular ndomtrial ithlium Whras th majority of th intgrins
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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ar amponstituti-ly 7rss throughout th ntir mnstrual ampyampl thr ar
intgrins hos 7rssion is inamprasd in th midlutal has r
roosd as marrs for th fram of indo of imlantation ntgrins ar
7rssd $y th human troho$last at th tim of imlantation
roho$lastiamp ramptors for 3gt inampras in amponamprt ith th diffrntiation
of human ampytotroho$last amplls to in-asi- 7tra-illous hnoty t is
hyothsi9d that ingrins hiamph ar rsnt on $oth th utrin ithlium
surfaamp and th thro$last $ind to sampifiamp 3gt ampomonnts2
-777 Ederia aiad0esi eues
As th attaamphing m$ryo aroaamphs th luminal ithlial surfaamp of
th utrus it nampountrs a muampinous latr h muampins in this layr ar a
grou of antiadhsi- molampul th most imortant of hiamph is muampin1
gt1 ts 7rssion is high during rimlantation riod hiamph rol in
shilding th imlanting $lastoampst from othr inhi$itiory faamptors on th
ithlial surfaamp n omn ho suffr rampurrnt misamparriag thr is
-idnamp for rduampd l-ls of gt1 suggsting that ths molampuls lay
signifiampant rol in th sta$lishmnt and maintnanamp of arly rgnanampy24
-77= Ederia y8ies
All tissus in-ol-d in imlantation ooampyt m$ryo and
ndomtrium ampan synthsi9 ampytoins h ampytoins that has -ital rol in
ndomtrial rampti-ity ar lumia inhi$itory faamptor LF intrluin1
L1 intrluin 11 and ampolony stimulating faamptor gtF nfrtil atints
and thos ith ratd imlantation failurs ha- $n shon to ha-
a$normal l-ls of LF suorting th rol of LF as fundamntal lmnt in
imlantation roampss L1 ampan ampaus inampras of intgrin M 7rssion
utation in gtF gn ampan dampras imlantation rat2
-77gt Ederia 9r0 ars
hr ar s-ral groth faamptors that has i-otal rol in imlantation
suamph as arin $indingidrmal groth faamptor 3F and F1
3F as 7rssd during th tim of ma7imal ndomtrial rampti-ity
and maintains a rol in $oth adhsion and d-lomnt in th m$ryo2
-7= Ederia assesse
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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3ndomtrial rampti-ity is th a$ility of th ndomtrium to suampampssfully attaamph
th $lastoampyst to nourish it and it ali- his ampan only $ aamphi-d aftr th
ndomtrium undrnt a num$r of histologiampal amphangs hil also inamprasing in
thiampnss Whil histiologiampal amphangs ampan only $ 7amind $y $iosy ultrasound is
a nonin-asi- asy and rlia$l mthod to masur aramtrs li thiampnss and
attrn20
-7= Ederia 0i8ess
3ndomtrial thiampnss ampan $ asily masur in th long a7is or
sagittal lan idally on trans-aginal sampanning h masurmnt of
ndomtrial thiampnss is ampon-ntionally massurd as a dou$l layr is of th
thiampst amphogniamp ara from on $asal ndomtrial intrfaamp aampross th
ndomtrial ampanal to th othr $asal surfaamp h dr hyoamphoiamp layr has
$n shon to rrsnt th most surfiampial layr of myomtrium and is not
inampludd in th ndomtrial masurmnt20
Figur 25 rans-aginal ultrasound shoing ndomtrial thiampnss
At rsnt rsults from studis that in-stigat th rlationshi
$tn ndomtrial thiampnss and ltF outampoms ar ositi- in ampouls
ith un7laind infrtility om studis found that thin ndomtrial
thiampnss ngati-ly affampts ltF othrs found that ndomtrial thiampnss
matamphd th ltF suampampss rats ositi-ly 3ndomtrial thiampnss amputoff
-aris from N= mm to 105 mm $for it shos a signifiampant inampras insuampampss rats for ltF tratmnt A study hld in th Oasmin gtlinis
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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gtitoangunusumo hosital +aarta shos an inamprasing ositi-
rdiampti- -alu ith inamprasing ndomtrial thiampnss ith th amputoff of
105 mm h ndomtrial thiampnss ge 105 mm hiamph rsultd in
rgnanampy and ndomtria thiampnss P 105 mm hiamph did not rsult in rgnanampy as tims highr than ndomtrial thiampnss P 105 mm hiamph
rsultd in rgnanampy and ndomtrial thiampnss ge 105 mm hiamph did not
rsult in rgnanampy=10
a$l 21 3ndomtrial thiampnss $tn rgnant and nonrgnant grou
-7=- Ederia vue
h ndomtrial -olum as assssd $y D ultrasound on th day of
m$ryonal transfr ampan $ usd to rdiampt ndomtrial rampti-ity
3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation
rats hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for
suampampssful ltF outampom 3ndomtrial -olum dampras signiampantly aftr th
administration of hgt in omn ho suampampd to amponampi- $ut not in thos
ho faild to do so20
3ndomtrial -olum is assssd ith D ultrasound using th -irtual
organ ampomutr aidd analysis ltgtAL his is a rotational mthod $asd
on rotation in gi-n sts 6deg deg 15deg 0deg on a gi-n orthogonal lan his
is th most aampampurat mthod ampomard to 2D-olum stimation21
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
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Figur 2= 3ndomtrial -olum ampalampulation
2343Ederia paer
3ndomtrial attrn on th day of ooampyt rtri-al ositi-ly
influnampd imlantation hr ar to tys of ndomtrial attrn that ampan
$ sn on ultrasound 7amination on of homognous amphogniampity and
on of a multilayrd or trillin amphogniampity rillin attrn as
dsampri$d as hyoamphogniamp ndomtrium surroundd $y hyramphogniamp
9on h rgnant omn had a signifiampantly highr rat of multilayrd
attrns rgnanampy rat in atints ith a multilayrd attrn and
ndomtrial thiampnss of Q mm in ampomarison in thos ith homognous
amphogniampity andIor thiampnss P mm20
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
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Figur 2= rillin attrn ndomtrium
2344Ederia bd
A good $lood suly toards th ndomtrium is usually amponsidrd
to $ an ssntial ruirmnt for imlantation 3ndomtrial and su$
ndomtrial $lood flo ampan $ mor o$jampti-ly and rlia$ly masurd $y
D Dolr ultrasound h 9ons of -asampular ntration into su$
ndomtrial and ndomtrial rgions ha- $n dfind asbull Ron th su$ndomtrial 9on
bull Ron th outr hyramphogniamp 9on
bull Ron th innr hyoamphogniamp 9on
ighr rgnanampy rat is o$sr-d hn th $lood flo to th
ndomtrium as in Ron ampomrd to Ron 21
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7262019 Referat Ivf and endometrial receptivity
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Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2028
Figur 2= Dolr $lood flo till 9on
-7gt Ederia reepiviy aa9ee
Whn a thinnr ndomtrium S= mm and notrillin ndomtrial attrn
ampo7ist in an ltFIgt ampandidat ampryorsr-ation should $ rampommndd
roadly saing thr ar s-ral stratgis that ampan $ util9d for imro-ing
ndomtrial rampti-ity22
1 o d-lo o-arian stimulation rotoampols that ampaus a minimum rduamption
in ndomtrial rampti-itiy or may -n inampras ita A-oid using amplomihn ampitrat gtgt that ampould imair ndomtrial
rampti-ity and ftal d-lomnt
$ gtorrampting th ndomtrial altrations induampd $y gtgt $y -aginal
hormonal sulmntation ith stradiol and rogstron hy
rortd normali9ation of altrations in ndomtrial morhology and
imro-mnt of ndomtrial rampti-itiy
amp A suffiampint amponampntration of strogn is nampssary for ndomtrial
rolifration during folliampular has for imlantation and for rogrss
of rgnanampy yiampal rgimn inampluds th folloing
bull to 20 mgIday oral strogn
bull to 10 mgIday oral strogn lus 200 microg stradiol atamphs tiamp
ly
d mro-ing ndomtrial rampti-ity $y damprasing stradiol l-ls
during th rimlantation riod in high rsondrs ith us of F
stdon rgimn gtontrolld o-arian hyrstimulation is assoampiatd
ith surahysiologiamp hormon l-ls ampomard ith natural ampyampls
16
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igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
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d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
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7262019 Referat Ivf and endometrial receptivity
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
1
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ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
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1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2128
igh stradiol l-ls hiamph ar non to $ intrampti- and altrd
stradiolIrogstron ratios hiamph ar also assoampiatd ith imairmnt
of ndomtrial rampti-ity in high rsondrs 3stradiol l-ls on th
day of gt administration ar signifiampantly lor ith th stdon
rgin ampomard ith th standard rotoampol h imlantation and
rgnanampy rats ar $ttr in st don rgimn
h arly lutal has of ampyampls undrgoing ampontrolld o-arian
hyrstimulation is ampharaamptri9d $y mardly l-atd srm
rogstron l-ls during th rio-ulatory riod and ad-anampd
ndomtrial histologiampal faturs 3arly rogstron ris has a
ngati- imaampt on ndomtrial rampti-ity that ampasu rmatur
ndomtrial lutini9ation and rmatur aaranamp of imantation
indo
f Anothr aroaamph that has $n usd to a-oid th rduampd ndomtrial
rampti-ity that undou$tdly oampampurs folloing o-arian hyrstimulation
is to rturn to natural ampyampl ltF
2 o imro- utrin -asamplari9ation
a Lo dos asirin =5150 mgIday tratmnt signifiampantly imro-s
utrin and o-arian $lood flo -loampity imlantation and rgnanampy
rats $y inhi$iting throm$o7an A2 ithout affampting th synthsis of
rostaampyamplin thus 7laining th inampras $lood flo -loampity in utrin
and o-arian artris
$ Larginin sulmntation imro-s th utrin $lood flo
ndomtrial rampti-ity imlantation and rgnanampy rats
amp ildnafil ampirat r-nts $radon of amp and otntiats th
ffampt of nitriamp o7id on -asampular smooth musampl A suggstd rotoampol
is -aginal sidnafil 25 mg four tims a day
o trat th athologiampal amponditions
a Lutal has dfampt 7ognous rogstron tratmnt ampan $ gi9n in
a susamptd dfiampinampy of rogstron in lutal has dfampt
$ Fi$roid distortd th utrin ampa-ity ar assoampiatd ith s-r
imairmnt of imlantation and should $ rmo-d
amp ntrautrin adhsions ampan $ tratd $y lysis undr dirampt -ision $y
hystrsosampoy
1=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2228
d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
18
7262019 Referat Ivf and endometrial receptivity
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
1
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2428
ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
20
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2528
-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
21
7262019 Referat Ivf and endometrial receptivity
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
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REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2228
d trin stum ampan $ tratd $y di-ision of th stum $y
hystrosampoy
ydrosalin7 h -M ndomtrial intgrin hiamph may mar th
imlantation indo r 7rssd at signifiampantly lor l-ls in
omn ith hydrosalin7 and rturnd to normal aftr rmo-al of
hydrosalin7
f 3ndomtriosis ampan $ tratd $y rolongd ituitaryo-arian
surssion using n agonist for 6 months gimn that ampan $
usd
bull Lurolid =5 mg monthly
bull KAfrlin 200 microg intranasally daily
bull osrlin 6 mg dot monthly
g Autoimmun amponditions An inampras in $oth imlantation and rgnanampy rats ith rdnisolon 20 mgIday and lo dos asirin
thray in autoanti$ody ositi- omn as dmonstratd
-= Resear0 Ederia Reepiviy ad IVF Suess Raes
gtohort study $y asius t al in-stigating th ffampt of ndomtrial thiampnss
on ltF outampoms diffrntiat ndomtrial thiampnss amputoff -alu of le = -rsus N =
mm h mtaanalysis for li- $irth and ongoing rgnanampy rats togthr
dmonstratd a trnd toards lor rgnanampy rats for omn ith thin
ndomtrium although ths diffrnamps did not raamph statistiampal signifiampanamp $ut th
ro$a$ility of amponampi-ing ith ndomtrial thiampnss le = mm as signifiampantly lor
hn ampomard ith ndomtrial thiampnss N = mm o $asd on this study it shos
that ndomtrial thiampnss has no rdiampti- ampaaampity for th oampampurnamp of rgnanampy
$ut it dos sm to $ a faamptor for th assssmnt of th ro$a$ility of amponampi-ing aftr
ltF t is unamplar hy thin ndomtrial thiampnss is assoampiatd ith oorr rgnanampy
rosampts it has $n sampulatd that $asal layr ndomtrium o7ygn amponampntration
ar inamprasd ith thin ndomtrial thiampnss igh o7ygn l-l might $ dtrimntal
for m$ryo imlantation
Tuantitati- study $y amphild t al uss dimnsional or dolr
sonograhy DD to 7amin th rlationshi $tn siral artry $lood flo
and -ssl dnsity on th first day of stimulation thray and su$sunt ltF
outampom his study also masur othr ndomtrial rampti-ity faamptors suamph as
ndomtrial thiampnss P 5 mm -olum utrin ulsatility ind7 and a systoliamp-loampity ths rampti-ity faamptors dosnEt sm to affampt rgnanampy rats aftr ltF
18
7262019 Referat Ivf and endometrial receptivity
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tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
1
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2428
ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
20
7262019 Referat Ivf and endometrial receptivity
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-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
21
7262019 Referat Ivf and endometrial receptivity
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C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2328
tratmnth DD ill analy9 th $lood flo uantitati-ly shoing th
-asampulari9ation ind7 lt hiamph dsampri$ th -ssl dnsity flo ind7 F hiamph
dsampri$ th intnsity of $lood flo and th -asampulari9ation flo ind7 ltF hiamph
assssd $oth -asampulari9ation and rfusion h rsults ar -ry su$ndomtrial
indiamps inampluding th lt F and ltF r signifiampantly affampt th rgnanampy rats aftr
ltF tratmnt and among th indiamps th F lays th strongst rdiampting faamptor of
ltF suampampss rats hrdimnsional indiamps that r o$sr-d in amponamption ampyampls
suggsts that lssr dgr of intrautrin -asampulari9ation and rfusion at th
$ginning of o-arian stimulation indiampatd a mor fa-ora$l ndomtiral n-ironmnt
n amponamplusion it is statd that at th initiation of o-arion stimulation folloing n
donrgulation thr ar signifiampant diffrnamps in su$ ndomtrial $lood flo
and -ssl dnsity that as found $tn su$suntly rgnant or nonrgnant
omn and may allo arlir rdiamption of a nonrampti- ndomtrium at a tim
hn furthr stimulation thray ampould $ ostond to a ampyampl ith a mor fa-ora$l
ndomtrial n-ironmnt8
Anothr uantitati- study $y Kg t al ampomaring ndomtrial thiampnss
utrin ulsatility ind7 rsistanamp ind7 ndomtrial -olum lt F and
Flt $tn intramural fi$roid atints and matamphd ampontrols his study also uss
DD to -aluat th ndomtrial rampti-ity faamptors hr r no diffrnamps in
ndomrial rampti-ity faamptors rgnanampy rats and imlantation rats $tn
atints ith or ithout intramural fi$roid aftr o-arian stimulation ith human
amphorioniamp gonadotroin gt gi-n intramusampularly12
trosampti- study of all ltF ampyampls rformd from +anuary 2005 until ay
200 $y Wio t al at Oasmin gtliniamp in +aarta study th amporrlation $tn
ndomtrial thiampnss and ltF ampyampl outampom h ltF tratmnt usd in this study
as d-idd into rotoampols long short or natural ampyampl h long rotoampol uss
n agonist and rampom$inant F rF hil th short rotoampol uss
ampom$ination of n antagonist and rF hy usd a 2 Dimnsiondison A
6000 gt trans-aginal ultrasound to masur th ndomtrial thiampnss on th day of
gt administration h rsults shos th ndomtrial thiampnss amputoff -alu of ge
105 mm Asid from ndomtrial thiampnss m$ryo amplls uality hiamph as assssd
$y th m$ryonal ampl-ag rat also ampontri$utd to rgnanampy outampom 3m$ryos ith
1
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2428
ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
20
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2528
-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
21
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2628
C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2428
ge 8 amplls in ampl-ag in this study mor dominantly ampontri$utd to rgnanampy
outampom10
saramph $y 3lRnnni t al assss th su$ndomtrial $lood flos and 3
lt3F in omn to inampras imlantation rat u$ndomtrial $lood flos rmasurd $y trans-aginal ultrasound ith utrin artry dolr -loampimtry and 3
lt3F as masurd using a rimary antilt3F A$=gtat h rsults sho omn
ith un7laind infrtility grou had signifiampantly lor lt3F l-l signifiampantly
thinnr ndomtrial thiampnss signifiampantly highr su$ndomtrial flo and
signifiampantly lor su$ndomtrial flo =
gtliniampal trial amponduamptd $y arad t al studis th ffampt of granuloampyt
ampolonystimulating faamptors gtF ffampt on ndomtrial thiampnss and imlantation
rat in ordr to l-at th suampampss rats of ltF t as rortd suampampssful ndomtrial
7ansion to at last minimal thiampnss of = mm aftr utrin rfusion ith gtF in
a small grou of omn ith thin ndomtrium ith rsistant to standard tratmnts
$ut thr ar no signifiampant ampliniampal $nfits hn it ampoms to imlantation rats or
ltF suampampss rats1
trosampti- study $y o t al suggstd that th us of intra-aginal
rogstron gtriampon 8B 0 mg is surior to th us of intramusampular
rogstron 50 mg for ltF tratmnt in ordr to inampras suampampss rats t as
found that th us of gtriampon 0 mg -aginal gl inamprass rgnanampy and imlantation
rats to a statistiampal signifiampanamp and rgnanampy outampom18
A randomi9d ampliniampal trial $y rna t al study th rol of stradiol
transdrmally in ampom$ination of suository intra-aginal rogstron aftr m$ryo
transfr to ampyampl outampom t as found thr is no $nfiampial outampom in atint
rampi-ing transdrmal stradiol aftr suository rogstron h rol of strogn in
human imlantation has $n 7tnsi-ly studid ndomtrial riming ith
rolifration of th glands stroma and -asampular -ssls is o$sr-d hn strogn is
administrd during folliampular has $ut th us of strogn on th lutal has is not
amplar1=
andomi9d ampliniampal trial $y Firou9a$adi t al study th ffampt of sildnafil
ampitrat on ndomtrial rration for ltF tratmnt outampom his study -aluats
th ndomtrial thiampnss using trans-aginal ultrasound on day 1 of th mnstrual
ampyampl and ampomaring $tn 2 diffrnt thray grous on rampi-ing stradiol
20
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2528
-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
21
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2628
C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2528
-alrat and th othr rampi-ing sildnafil ampitrat h outampom of this study is that
suldnafil ampitrat ha- signifiampantly thiampr ndomtrial highr imlantation rat and
also highr rgnanampy rats16
21
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2628
C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2628
C6APTER III
CONCLUSION
n -itro frtili9ation ltF rfrs to a roampdur dsignd to o-rampom infrtility and
roduamp a rgnanampy as a dirampt rsult of th intr-ntion h rinampial sts of ltF ar
don rgulation using n agonist ampontrolld o-arian hyrstimulation monitoring of
folliampular groth ooampyt rtri-al frtili9ation in -itri transfr of gamts or m$ryos to
ndomtrium and lutal suort ith rogstron
3ndomtrial rampti-ity lays a ampruampial rol in th sta$lishmnt of a halthy
rgnanampy in ampyampls of assistd rroduamption 3ndomtrial rampti-ity is th a$ility of th
ndomtrium to suampampssfully attaamph th $lastoampyst to nourish it and it ali-
ltrasound is a nonin-asi- asy and rlia$l mthod to masur aramtrs li
thiampnss and attrn rgnanampy rat in atints ith a multilayrd attrn and ndomtrial
thiampnss of Q mm in ampomarison in thos ith homognous amphogniampity andIor thiampnss
P mm 3ndomtrial -olum of P2 ml rsultd in signifiampantly lor inlantation rats
hras an ndomtrial -olum of N 2 ml as a ositi- rdiamptor for suampampssful ltF
outampom ighr rgnanampy rat is o$sr-d hn th $lood flo to th ndomtrium as in
Ron ampomrd to Ron h stratgis that ampan $ util9d for imro-ing ndomtrial rampti-ity ar
d-loing o-arian stimulation rotoampols that ampaus a minimum rduamption in ndomtrial
rampti-itiy imro-ing utrin -asampulari9ation and trating th athlogiampal amponditions that
ampan ampaus ndomtrial imairmnt
22
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2728
REFERENCES
1 Dutta D iralal Dgt DuttaEs 7t$oo of $sttriamps =th d K Dlhi +ay
rothrs diampal u$lishrs 2014
2 aifuddin A aamphimhadhi Winjosastro lmu $idanan 4th d +aarta ina ustaa arono rairohardjo 2014
gtunningham F Williams + Williams o$sttriamps K Oor ampraill diampal
2010
4 amphorg + Williams + Williams gynampology K Oor ampraill diampal 2008
5 oamphamad A Ali rajitno lmu ndungan rd d +aarta ina ustaa
arono rairohardjo 2011
6 asamparnhas Fla7man orma ltandrol t-ns Kational gional
and lo$al rnds in nfrtility r-alnamp inamp 10 A ystmatiamp Analysis of 2==
alth ur-ys Lo d 201212100156
= 3lRnnni oustafa A$dlaf9 3lalally A$dladr A 3lnaggar
A Assssmnt of utrin su$ndomtrial $lood flos and ndomtrial gland -asampular
ndothlial groth faamptor 3lt3F in omn ith un7laind infrtility iddl
3ast Frtility oampity +ournal 201520211126
8 amphild Tuantitati- assssmnt of su$ndomtrial $lood flo $y thr
dimnsionalultrasound is an imortant rdiampti- faamptor of imlantation in an in-itro
frtili9ation rogramm uman roduamption 200015184
asius A mit + orranamp 3ijmans ol mr t al 3ndomtrial
thiampnss and rgnanampy rats aftr ltF a systmatiamp r-i and mtaanalysis
uman roduamption dat 201420450541
10 Wio stiantoro A Katadiasastra umaradja Kot only m$ryo uality
$ut also 3ndomtrial hiampnss gtontri$uts to ltF outampom a rtrosampti- study ofall ltF ampyampls in Oasmin gtliniamp +aarta ndonsia 3ndomtrial thiampnss ampontri$uts
to ltF outampom 20164111 httIIutodatampomIampontntsIin-itro
frtili9ation
11 Dutta D onar Dgt DuttaUs 7t$oo of ynampology 6th d K Dlhi +ay
rothrs diampal u$lishrs 2014
12 Ou Kg 3 3ndomtrial and su$ndomtrial $lood flo masurd $y thrdimnsional
or Dolr ultrasound in atints ith small intramural utrin fi$roids during
ltF tratmnt uman roduamption 2004202501506
1 arad D Ou O ushnir lt hohatal A La99aroni 3 L t al A randomi9d
ampliniampal trial of ndomtrial rfusion ith granuloampyt ampolonystimulating faamptor in
in -itro frtili9ation ampyampls imaampt on ndomtrial thiampnss and ampliniampal rgnanampyrats Frtility and trility 2014101=10=15
14 utton D A 7t$oo of radiology and imaging =th d 3din$urgh gthuramphill
Li-ingston 200
15 ainFnning K h rroduampi$ility of ndomtrial -olum aampuisition and
masurmnt ith th ltgtALimaging rogram u$d Kgt Vntrnt
Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l from
httIInamp$inlmnihgo-Iu$mdI11851=2
16 Dhghani Firou9a$adi 3ffampt of sildnafil ampitrat on ndomtrial raration and
outampom of fro9nthad m$ryo transfr ampyampls a randomi9d ampliniampal trial
u$d Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l
from httIInamp$inlmnihgo-Iu$mdI246=41
2
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=
7262019 Referat Ivf and endometrial receptivity
httpslidepdfcomreaderfullreferat-ivf-and-endometrial-receptivity 2828
1= rna + 3stradiol sulmntation during th lutal has of ltFgt atints a
randomi9d ampontrolld trial u$d Kgt Vntrnt Kamp$inlmnihgo- 2016
Vampitd 6 Aril 2016 A-aila$l from httIInamp$inlmnihgo-Iu$mdI181184=
18 o gt Lutal suort for ltFIgt ampyampls ith gtrinon 8B 0 mg tiamp daily
rsults in highr rgnanampy rats than ith intramusampular rogstron u$d
Kgt Vntrnt Kamp$inlmnihgo- 2016 Vampitd 6 Aril 2016 A-aila$l fromhttIInamp$inlmnihgo-Iu$mdI18==211=
1 irti ani A rif -i on nltitro frtili9ation ltF An ad-anampd and
miraampulous gatay for infrtility ratmnts WLD + harm harm ampi
2014464=C58
20 gr A ator itrosi D 3ndomtrial ampti-ity and its rdiampti- ltalu for
ltFIgtutampom $urtshilf und Fraunhilund 2012=208=10=15
21 ahadur A ittal alhotra K hatt A ingh K rdiampti- -alu of ndomtrial
thiampnss attrn and su$ndomtrial $lood flos on th day of hgt $y 2D dolr
in in-itro frtili9ation ampyampls A rosampti- ampliniampal study from a trtiary ampar unit +
um rod ampi 2011412
22 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 20042 Aamphaamph -l A 3ndomtrial rampti-ity marrs th journy to suampampssful
m$ryo imlantation uman roduamption dat 2006126=1=46
24 3lnashar A A$oul3non 3ndomtrial rampti-ity 3F+ 1 2004
25 gtama aylor mlantation failur molampular mamphanisms and ampliniampal
tratmnt Human Reproduction Update 20111=224225
doi1010IhumudIdm0=