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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
Implantation is the process by which the blastocyst comes into intimate physical and physiological contact with the uterine endometrium. It requires competent embryo, receptive endometrium, synchrony between development of embryo and conditioning of uterus, factors involved in regulation of blastocyst implantation. This chapter covers the preimplantation embryo development and genomic activation, hatching of blastocyst, morphological steps of implantation, factors influencing implantation, immune acceptance of pregnancy, embryo– maternal cross talk, and mechanisms at the trophoblast to escape immune attack. Blastocyst implantation requires a competent embryo and its ability to cross talk with a receptive endometrium, and the dialogue must talk about immunity and angiogenesis. The uterus is tailored to tolerate the fetal allograft and to allow controlled invasiveness of trophoblast only during the WOI, ensuring the success of the intricate cascade of implantation. It still remains an enigmatic process with many unknown factors and interactions.