Rifat GRSOY, M.D. GAZ UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GYNECOLOGY AND OBSTETRICS REPRODCTIVE ENDOCRINOLOGY AND INFERTILITY DIVISION GVEN HOSPITAL ASSISTED REPRODUDTIVE TECHNOLOGIES CENTER IVF UNIT A N K A R A The Role of Endometrium on ART Success 2nd.Congress of Reproductive Endocrinology, Reproductive Endocrinology, Assisted Reproductive Technologies And 1st Congress of Repoductive Medicine Society (TD) Implantation Complex series of interactions between heterogenous cell types of the uterus and the blastocyst Implantation Apposition Apposition Adhesion Adhesion Invasion Invasion Implantation Window Ovulation Cycle Days 20-24 Natural and Stimulated Cycles Endometrial Biopsy In-Phase In-Phase Ful secretory transformation Ful secretory transformation Receptive endometrium Receptive endometrium Out-of-Phase Out-of-Phase Incomplete or absent secretory tranformation Incomplete or absent secretory tranformation Noyes et al Implantation Window If blastocysts transfer to uterus before decidualization,they can wait until decidualization before implantation If blastocysts transfer to uterus before decidualization,they can wait until decidualization before implantation If early stage embriyos transfer to decidualized endometrium,they can not reach to blastocyst stage so successfully If early stage embriyos transfer to decidualized endometrium,they can not reach to blastocyst stage so successfully Time of natual implantation and loss of pregnancy Wilcox et al Spandorfer et al Spandofer et al Spandorfer et al Hysteroscopy Hysteroscopic appearance of mid-secretory endometrium in releation to early phase pregnancy outcome has been found to be better prognostic factor than any hormonal data investigated at this stage of menstruel cycle Hysteroscopic appearance of mid-secretory endometrium in releation to early phase pregnancy outcome has been found to be better prognostic factor than any hormonal data investigated at this stage of menstruel cycle Kanazawa Good hysteroscopic appearance Poor hysteroscopic appearance Ongoing Pregnancy Rates Microarchitecture by scanning electron microscope Sonography High resolution ultrasonography serves as a non-invasive alternative method using endometrial pattern and thickness to assess endometrial receptivity High resolution ultrasonography serves as a non-invasive alternative method using endometrial pattern and thickness to assess endometrial receptivity Endometrial pattern Endometrial pattern Endometrial thickness Endometrial thickness Sonography Sonography Hypoechoic texture:Central echogenic line during proliferative phase Hypoechoic texture:Central echogenic line during proliferative phase Hyperechogenic texture:Lacking central echogenic line during secretory phase Hyperechogenic texture:Lacking central echogenic line during secretory phase Sonography Lack of homogenous hyperechogenic pattern in COH+IVF Lack of homogenous hyperechogenic pattern in COH+IVF DECREASED FECUNDITY COH may have an adverse effect on implantation COH may have an adverse effect on implantation Check et al Check et al (fresh embryo) Check et al (frozen embryo) Premature hyperechogenic pattern of endometrium Fanchin et al Endometrial thichness Considerable contraversy concern Considerable contraversy concern Predictive value for treatment outcome Predictive value for treatment outcome In younger patients In younger patients Who require prolonged gonadotrophin stimulation Who require prolonged gonadotrophin stimulation Those who have poor quality embryos Those who have poor quality embryos Endometrial Thickness Zhang et al Endometrial voulme by 3D Zollner et al 3D Power Doppler Sonography Jinno etal Subendometrial Blood Flow by 3D Power Doppler Wu et al (vascularization flow index) MAJOR TAKE HOME POINTS Implantation rates in ART have not improved during last decade Implantation rates in ART have not improved during last decade Implantation is still an enigma Implantation is still an enigma Endometrial thickness and pattern are still the most Endometrial thickness and pattern are still the most reliable (!) criteria about endometrial receptivity in ART practice We do need to know more about microarchitecture,biochemical and molecular markers We do need to know more about microarchitecture,biochemical and molecular markers