The implantation window is defined as that period when the uterus is receptive for implantation of the free-lying blastocyst. This period of receptivity is short and results from the programmed sequence of the action of oestrogen and progesterone on the endometrium. Implantation itself is a process that commences with apposition, continues through attachment to trophoblast outgrowth and decidualization. For maximal effectiveness of assisted reproductive technologies in women, it is important to know the optimal time for embryo transfer which implies a need to predict the period of uterine receptivity. At present there are no good markers of, or for prediction of, uterine receptivity. In cycles where endogenous hormonal activity is suppressed or absent, the optimal time for embryo transfer can be easily defined and lies between luteal days +3 to +5, where luteal day +1 is the first day of exogenous progesterone treatment. In the human, it is suggested that blastocyst apposition begins about LH day +6 and is complete by LH +10. Human embryos survive in vitro manipulation well, and the stage of development at which they are placed in the uterus seems less critical than in other species, provided they are at an earlier stage of development than that of the endometrium.

The implantation window.

The prevalence of male infertility and the availability of new, highly successful therapeutic options make the testing of sperm functional competence mandatory. An objective, outcome-based examination of the validity of the currently available assays was performed based upon the results obtained from 2906 subjects evaluated in 34 prospectively designed, controlled studies. The aim was carried out through a meta-analytical approach that examined the predictive value of four categories of sperm functional assays: computer-aided sperm motion analysis (CASA); induced-acrosome reaction testing; sperm penetration assay (SPA); and sperm-zona pellucida binding assays for IVF outcome. Results demonstrated a high predictive power of the sperm-zona pellucida binding and the induced-acrosome reaction assays for fertilization outcome. On the other hand, the findings indicated a poor clinical value of the SPA as predictor of fertilization and a real need for standardization and further investigation of the potential clinical utility of CASA systems. This analysis points out to limitations of the current tests and the need for standardization of methodologies and provides objective evidence on which clinical management and future research can be based.

Sperm function assays and their predictive value for fertilization outcome in IVF therapy: a meta-analysis

Ultra high field NMR spectroscopic studies on human seminal fluid, seminal vesicle and prostatic secretions

Evidence for the Autocrine Induction of Capacitation of Mammalian Spermatozoa

Atrial natriuretic peptides (ANPs) from several species induced the human acrosome reaction. The maximal response was highest for human ANP (18.6% above unstimulated or baseline values) and decreased progressively for peptides derived from animals lower on the phylogenetic scale. ANP concentrations required for a half-maximal effect in noncapacitated spermatozoa ranged from 0.07 to 0.38 nM. ANP induced the acrosome reaction in capacitated spermatozoa, but the concentration required was higher than in noncapacitated cells. The response in noncapacitated spermatozoa was independent of added extracellular Ca2+ and was completely inhibited by 1 microM LY83583 (inhibits particulate guanylate cyclase). However, 10 microM N omega-nitro-L-arginine (inhibits soluble guanylate cyclase) had no effect. ANP (80 pM) and 3 microM 1,2-dihexanoyl-sn-glycerol each induced a nearly half-maximal acrosome reaction. Added in combination, they produced no increased response, suggesting antagonism. Follicular fluid had variable levels of immunoreactive ANP. Average ANP content was nearly zero in samples that contained no oocyte at the time of aspiration but was higher (6.9 pM; 90% confidence limits = 1.67-28.72 pM) in follicular fluid containing oocytes that did not fertilize in vitro. Highest concentrations of ANP were present in follicular fluid containing oocytes that fertilized in vitro (72.8 pM; 90% confidence limits = 38.1-139.1 pM). These data suggest that noncapacitated spermatozoa can acrosome react without added extracellular Ca2+ in response to an extracellular ligand. Also, human spermatozoa appear to contain receptors for ANP similar to those found in other cell types. The ANP content of follicular fluid might partly explain the ability of follicular fluid to induce the acrosome reaction.

Atrial natriuretic peptide (ANP) as a stimulus of the human acrosome reaction and a component of ovarian follicular fluid : correlation of follicular ANP content with in vitro fertilization outcome

Raymond A. Tom

Papers

Platelet-activating factor in sperm from fertile and subfertile men.

Optimizing the sperm penetration assay with human follicular fluid.

Assessment of male infertility: correlation between results of semen analysis and phosphorus-31 magnetic resonance spectroscopy.