The impact of embryonic development and endometrial maturity on the timing of implantation.
OBJECTIVE
To gain insight into the peri-implantation period in the human and to answer the question whether timing of nidation is dependent on the stage of embryonic development, endometrial maturation, or a possible dialogue between the two.


METHODS
Seventy-five women underwent embryo transfer (ET) throughout 93 cycles. Thirty-three ETs resulted in viable pregnancies and deliveries. These pregnancy cycles were used for embryonic signal detection. Embryos of identical age were transferred onto hormonally and histologically defined endometria of different maturational stages (days 15 to 19). Human chorionic gonadotropin (hCG) was measured by a hypersensitive chemiluminescence assay in maternal serum every 1 to 5 days to detect the first embryonic signal.


RESULTS
Individual linear regressions of hCG versus embryonic age and endometrial maturation were performed on 33 viable pregnancy cycles (r2 = 90.5% to 99.9%, P less than 0.02 to 0.002). First signal detection was restricted to an embryonic age of 7.1 +/- 0.28 (mean +/- SD) days (range 6.6 to 7.4) irrespective of endometrial maturation. The pattern of hCG detection was triphasic, described by a sigmoidal curve with the maximal slope corresponding to an hCG doubling time of 15.9 hours. Embryo transfers on cycle day 19 had a steeper slope of hCG detection than days 15 and 16 (P less than 0.05).


CONCLUSIONS
First embryonic signal detection (presumed window of implantation) extends between cycle days 20 and 24. Implantation is dependent on embryonic age and is independent of endometrial maturation within this window. The timing and sigmoidal pattern of hCG detection coincides with structural changes of the implantation bed. The steeper slope of late ETs may represent a compensatory mechanism for late maternal recognition of pregnancy for corpus luteum rescue.
Bergh
P A
PA
Department of Obstetrics and Gynecology, Mount Sinai Medical Center, New York, New York 10029.
Navot
D
D
D001755:Blastocyst / Q000502:physiology; D006063:Chorionic Gonadotropin / Q000097:blood; D010064:Embryo Implantation / Q000502:physiology*; D004624:Embryo Transfer / Q000379:methods*; D005314:Embryonic and Fetal Development; D004717:Endometrium / Q000502:physiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D012044:Regression Analysis; D013997:Time Factors
D006063:Chorionic Gonadotropin