Vol 94, No 4 (2023)
Review paper
Published online: 2022-06-06

open access

Page views 2226
Article views/downloads 457
Get Citation

Connect on Social Media

Connect on Social Media

Implantation of embryos. The way for the improvement of the cumulative life birth rate (CLBR) in the assisted reproductive technology (ART)

Marian Szamatowicz12, Jacek Szamatowicz3
Pubmed: 35894483
Ginekol Pol 2023;94(4):326-329.


Despite the willingness, humans belong to the species with the limited procreation possibilities. Infertility affects about 15% of population is the very important subject for the reproductive medicine. An assisted reproductive technology (ART) offers the significant chance for the infertile couples, but it does not give the guarantee for the pregnancy and for the birth of a healthy child. The implantation of embryo, despite numerous trials and attempts, remain the last barrier in the assisted reproduction technologies; thus, the endometrial receptivity becomes the subject of permanent interest. In this review we have tried to present various methods of improvement of an endometrial receptivity with the conclusion that we still wait for the valuable prognostic factor in the treatment of infertility by ART which could predict the chance for the birth of a healthy child.

Article available in PDF format

View PDF Download PDF file


  1. Boivin J, Bunting L, Collins JA, et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007; 22(6): 1506–1512.
  2. Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015; 21(4): 411–426.
  3. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016; 22(6): 687–708.
  4. Ray A, Shah A, Gudi A, et al. Unexplained infertility: an update and review of practice. Reprod Biomed Online. 2012; 24(6): 591–602.
  5. Edwards RG, Edwards RG. Human implantation: the last barrier in assisted reproduction technologies? Reprod Biomed Online. 2006; 13(6): 887–904.
  6. Fathalla MF. Current challenges in assisted reproduction. In: Vaegter E, Rowe PJ, Griffin PD. ed. Current Practices and Controversies in Assisted Reproduction. Report of a Meeting on „Medical and Social Aspects of Assisted Re-production”. Hel dat WHO Headquarters in Geneva 2001: 17–21.
  7. Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009; 360(3): 236–243.
  8. Paul R, Fitzgerald O, Lieberman D, et al. Cumulative live birth rates for women returning to ART treatment for a second ART-conceived child. Hum Reprod. 2020; 35(6): 1432–1440.
  9. Høyer S, Kesmodel U, Aagaard J. Conditional and cumulative live birth rates after blastocyst transfer. Eur J Obstet Gynecol Reprod Biol. 2021; 261: 46–51.
  10. Guzeloglu-Kayisli O, Kayisli U, Taylor H. The Role of Growth Factors and Cytokines during Implantation: Endocrine and Paracrine Interactions. Semin Reprod Med. 2009; 27(01): 062–079.
  11. Fox C, Morin S, Jeong JW, et al. Local and systemic factors and implantation: what is the evidence? Fertil Steril. 2016; 105(4): 873–884.
  12. Kim SM, Kim JS. A Review of Mechanisms of Implantation. Dev Reprod. 2017; 21(4): 351–359.
  13. Hernández-Vargas P, Muñoz M, Domínguez F. Identifying biomarkers for predicting successful embryo implantation: applying single to multi-OMICs to improve reproductive outcomes. Hum Reprod Update. 2020; 26(2): 264–301.
  14. Acosta A, Elberger L, Borghi M, et al. Endometrial dating and determination of the window of implantation in healthy fertile women. Fertil Steril. 2000; 73(4): 788–798.
  15. Achache H, Revel A. Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod Update. 2006; 12(6): 731–746.
  16. Lessey B, Young S. What exactly is endometrial receptivity? Fertil Steril. 2019; 111(4): 611–617.
  17. Massimiani M, Lacconi V, La Civita F, et al. Molecular Signaling Regulating Endometrium-Blastocyst Crosstalk. Int J Mol Sci. 2019; 21(1).
  18. Alfer J, Fattahi A, Bleisinger N, et al. Endometrial Dating Method Detects Individual Maturation Sequences During the Secretory Phase. In Vivo. 2020; 34(4): 1951–1963.
  19. Kupesic S, Bekavac I, et al. Assessement of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasono-graphy in patients undergoing in vitro fertilization procedures. J Ultrasoun Med. 2001; 20(2): 125–134.
  20. Craciunas L, Gallos I, Chu J, et al. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum Reprod Update. 2019; 25(2): 202–223.
  21. Mirkin S, Arslan M, Churikov D, et al. In search of candidate genes critically expressed in the human endometrium during the window of implantation. Hum Reprod. 2005; 20(8): 2104–2117.
  22. Hafiz P, Nematollahi M, Boostani R, et al. Predicting Implantation Outcome of In Vitro Fertilization and Intracytoplasmic Sperm Injection Using Data Mining Techniques. Int J Fertil Steril. 2017; 11(3): 184–190.
  23. Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015; 30(2): 323–330.
  24. Makrigiannakis A, Makrygiannakis F, Vrekoussis T. Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures. Front Cell Dev Biol. 2021; 9: 613277.
  25. Levi AJ, Drews MR, et al. Controlled ovarian hyperstimulation does not adversely affect endometrial receptivity in in vitro fertilization cycles. Fertil Steril. 2001; 76(4): 670–674.
  26. Masschaele T, Derris J, et al. Does transfering three or more embryos make sense for a wlldefined population of infertility patients undergoing IVF/ICSI? Facts Views Obgyn. 2012; 4(1): 51–58.
  27. Dieamant FC, Petersen CG, Mauri AL, et al. Fresh embryos versus freeze-all embryos - transfer strategies: Nuances of a meta-analysis. JBRA Assist Reprod. 2017; 21(3): 260–272.
  28. Singh B, Reschke L, Segars J, et al. Frozen-thawed embryo transfer: the potential importance of the corpus luteum in preventing obstetrical complications. Fertil Steril. 2020; 113(2): 252–257.
  29. Ruopp MD, Collins TC, Whitcomb BW, et al. Evidence of absence or absence of evidence? A reanalysis of the effects of low-dose aspirin in in vitro fertilization. Fertil Steril. 2008; 90(1): 71–76.
  30. So S, Yamaguchi W, Murabayashi N, et al. Beneficial effect of l-arginine in women using assisted reproductive technologies: a small-scale randomized controlled trial. Nutr Res. 2020; 82: 67–73.
  31. Ohl J, Lefèbvre-Maunoury C, Wittemer C, et al. Nitric oxide donors for patients undergoing IVF. A prospective, double-blind, randomized, placebo-controlled trial. Hum Reprod. 2002; 17(10): 2615–2620.
  32. Moini A, Zafarani F, Jahangiri N, et al. The Effect of Vaginal Sildenafil on The Outcome of Assisted Reproductive Technology Cycles in Patients with Repeated Implantation Failures: A Randomized Placebo-Controlled Trial. Int J Fertil Steril. 2020; 13(4): 289–295.
  33. Mizrachi Y, Horowitz E, Ganer Herman H, et al. ESHRE Capri Workshop Group. An update of luteal phase support in stimulated IVF cycles. Hum Reprod Update. 2007; 13(6): 581–590.
  34. Tang H, Mourad SM, Wang A, et al. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2021; 4: CD008605.
  35. Ojo-Carons M, Mumford SL, Armstrong AY, et al. Is Myomectomy Prior to Assisted Reproductive Technology Cost Effective in Women with Intramural Fibroids? Gynecol Obstet Invest. 2016; 81(5): 442–446.
  36. Catena U, Campo R, Bolomini G, et al. New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique. Facts Views Vis Obgyn. 2021; 13(1): 67–71.
  37. Strandell A, Lindhard A. Hydrosalpinx and ART. Salpingectomy prior to IVF can be recommended to a well-defined subgroup of patients. Hum Reprod. 2000; 15(10): 2072–2074.
  38. Nastri CO, Ferriani RA, Raine-Fenning N, et al. Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial. Ultrasound Obstet Gynecol. 2013; 42(4): 375–382.
  39. van Hoogenhuijze NE, Kasius JC, Broekmans FJM, et al. Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis. Hum Reprod Open. 2019; 2019(1): hoy025.
  40. Mackens S, Racca A, Van de Velde H, et al. Follicular-phase endometrial scratching: a truncated randomized controlled trial. Hum Reprod. 2020; 35(5): 1090–1098.
  41. Mouanness M, Ali-Bynom S, Jackman J, et al. Use of Intra-uterine Injection of Platelet-rich Plasma (PRP) for Endometrial Receptivity and Thickness: a Literature Review of the Mechanisms of Action . Reprod Sci. 2021; 28(6): 1659–1670.
  42. Larue L, Keromnes G, Massari A, et al. Transvaginal ultrasound-guided embryo transfer in IVF. J Gynecol Obstet Hum Reprod. 2017; 46(5): 411–416.
  43. Bortoletto P, Bakkensen J, Anchan RM. Embryo transfer: timing and techniques. Minerva Endocrinol. 2018; 43(1): 57–68.
  44. Szamatowicz M, Szamatowicz J. Proven and unproven methods for diagnosis and treatment of infertility. Adv Med Sci. 2020; 65(1): 93–96.
  45. Sadeghi MR. Low Success Rate of ART, an Illusion, a Reality or Simply a Too High Expectation? J Reprod Infertil. 2012; 13(3): 123.
  46. Miravet-Valenciano JA, Rincon-Bertolin A, Vilella F, et al. Understanding and improving endometrial receptivity. Curr Opin Obstet Gynecol. 2015; 27(3): 187–192.