Implantation Biological and Clinical Aspects

The advent of assisted conception procedures such as in-vitro fertili­ sation (IVF) has provided the impetus for exploration of the factors that lead to the establishment of pregnancy. This collection of papers from leading research workers brings together current concepts of the processes which may be of importance in implantation. The complex signals from the embryo to the ovary, endometrium and myometrium are now being revealed through studies in both primates and other mammalian species. This book addresses the interrelationship of pituitary and ovarian hormones in controlling ovulation and the preparation of the intrauterine environment for implantation. Once fertilisation has occurred and trophoblast has formed, the next vital step is the production of materials which signal the presence of the pregnancy to the rest of the body. Trophoblastic proteins and other early-pregnancy factors are prime candidates for this role. Recent studies have emphasised the importance of the intrauterine environment in implantation. Specific secretory products of the endometrium have great potential in this process. The prostaglandins also play an essential part. Immunological adjustments are now considered a condition for the successful establishment of pregnancy. The possible use of immuno­ therapy in the treatment of recurrent abortion has highlighted interest in this area. The use of immunological techniques for contraception are in their infancy but offer much hope for the future.

Section I: General.- 1 Embryo Implantation in Primates.- Section II: Pituitary and Ovarian Hormones.- 2 Pituitary and Ovarian Hormones in Implantation and Early Pregnancy.- Section III: Placental Hormones and Proteins.- 3 Recognition of Early Pregnancy: Human Chorionic Gonadotrophin.- 4 Recognition of Early Pregnancy: Human Placental Lactogen and Schwangerschaftsprotein 1.- 5 Pregnancy-Associated Plasma Protein-A: Fact, Fiction and Future.- 6 Embryo-Derived Platelet Activating Factor.- Section IV: Endometrial/Decidual Proteins.- 7 Synthesis and Secretion of Proteins by the Endometrium and Decidua.- 8 Characterisation, Biological Action and Clinical Studies of Endometrial Proteins.- 9 Biological Activity of Placental Protein 14.- Section V: Prostaglandins in Reproduction.- 10 Prostaglandins and the Establishment of Pregnancy.- Section VI: Reproductive Immunology.- 11 Current Concepts of Immunoregulation of Implantation.- 12 The Complement System in Normal Pregnancy.- 13 Spontaneous and Recurrent Abortion: Epidemiological and Immunological Considerations.- 14 Contraception: An Immunological Approach.- Section VII: Clinical Aspects.- 15 Early Pregnancy and its Failure after Assisted Conception: Diagnosis by Ultrasonic and Biochemical Techniques.- 16 Investigation and Control of Embryo Implantation in an In-Vitro Fertilisation Programme.- 17 Ectopic Pregnancy: Diagnostic Aspects.- 18 Treatments to Enhance Implantation.