Referat Ivf and endometrial receptivity

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



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



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



iii



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

1



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



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



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



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

5



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

6



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

=



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



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



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



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

11



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

12



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

1



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



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

15



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



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=



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



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



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



-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



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


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



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


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



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=



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



CONTENTS

FORE5ORD i





221 Dfinition6

222 ndiampation6





trin Lining














ats18


REFERENCES-7

ii



iii



C6APTER I

INTRODUCTION

+a89rud





















462B248








1










2



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



CONTENTS

FORE5ORD i





221 Dfinition6

222 ndiampation6





trin Lining














ats18


REFERENCES-7

ii



iii



C6APTER I

INTRODUCTION

+a89rud





















462B248








1










2



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



iii



C6APTER I

INTRODUCTION

+a89rud





















462B248








1










2



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



C6APTER I

INTRODUCTION

+a89rud





















462B248








1










2



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=










2



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



C6APTER II

LITERATURE REVIE5

21 Aay Ederiu









































4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




















4























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=























5














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=














-- I Vir Feriiai

-- Deiii








--- Idiai


bull u$al disas





bull -arian failur




6










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=










-7 Ederia reepiviy






-7 Ebryi ipaai




















=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=






ndomtrium2


-7- Ipaai perid








ndoamprin n-ironmnt




8





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=





























































ftal tissu2











10




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




















-77= Ederia y8ies














-7= Ederia assesse

11








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=








attrn20

-7= Ederia 0i8ess















12










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=










-7=- Ederia vue







ho faild to do so20





1




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




2343Ederia paer










14




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




2344Ederia bd










15





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=





















ly





16















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=















indo









and o-arian artris












hystrsosampoy

1=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




hystrosampoy




hydrosalin7



usd

























18



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



































1




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=




outampom10


























amplar1=





20






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=






21



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



C6APTER III

CONCLUSION



















22



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=



REFERENCES





2010






alth ur-ys Lo d 201212100156














frtili9ation










Li-ingston 200









2











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=











2014464=C58






um rod ampi 2011412






doi1010IhumudIdm0=

Referat Ivf and endometrial receptivity

Documents

Transcript of Referat Ivf and endometrial receptivity