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There is no universal definition for the 'poor responder'. Numerous strategies have been proposed to improve ovarian stimulation in poor responders, but none of them is the ideal for all such patients. More data from good quality controlled trials are needed.

A simple, safe and cost-effective treatment protocol in ovarian stimulation is of great importance in IVF practice, especially in the case of previous unsuccessful attempts. hCG has been used as a substitute of LH because of the degree of homology between the two hormones. The main aim of this prospective randomized study was to determine, for the first time, whether low dose hCG added to rFSH for ovarian stimulation could produce better results compared to the addition of rLH in women entering IVF-ET, especially in those women that had previous IVF failures. An additional aim was to find an indicator that would allow us to follow-up ovarian stimulation and, possibly, modify it in order to achieve a better IVF outcome; and that indicator may be the cDNA copies of the LH/hCG receptor. Group A patients (n = 58) were administered hCG and Group B rLH (n = 56) in addition to rFSH in the first days of ovarian stimulation. The number of follicles and oocytes and, most importantly, implantation and pregnancy rates were shown to be statistically significantly higher in the hCG group. This study has also determined, for the first time to our best knowledge, m-RNA for LH/hCG receptors in the lymphocytes of peripheral blood 40 h before ovum pick-up. cDNA levels of the hCG receptor after ovarian stimulation were significantly higher among women receiving hCG compared to those receiving LH. In addition, higher levels were encountered among women with pregnancy compared to those without, although this was not statistically significant due to the small number of pregnancies. It seems that hCG permits a highly effective and more stable occupancy of rLH/hCG receptors and gives more follicles and more oocytes. The determination of cDNA copies could be, in the future, a marker during ovulation induction protocols and of course a predictor for the outcome of ART in the special subgroup of patients with previous failures.

CEACAM1 (CD66a, C-CAM, BGP) is an adhesion molecule of the carcinoembryonic antigen family which has been shown to be normally expressed at the apical pole of epithelial cells, including the apical pole of endometrial surface and glandular epithelia. The purpose of the present study was to investigate its expression pattern at the maternal-fetal interface, and thus to determine whether CEACAM1 could be implicated in the human implantation process. For this purpose, we performed immunohistochemistry using the 4D1/C2 monoclonal antibody (mAb) as well as flow cytometry and Western blot on isolated trophoblast populations. On the maternal side of the maternalfetal interface, CEACAM1 was present in epithelial cells of pregnancy endometrium as well as in small endometrial vessels, whereas it was absent from decidual cells. On the fetal side, CEACAM1 was strongly expressed by the extravillous (intermediate) trophoblast at the implantation site, as well as by extravillous trophoblast cells with invasive phenotype in primary culture, as shown by flow cytometry and Western blot. Expression was also observed in placental villous core vessels but was absent from both villous cyto-and syncytiotrophoblasts throughout the pregnancy. We conclude that, given its specific ex- The trophoblast is the first tissue to differentiate in the mammalian conceptus and its normal development and specific properties are crucial for both implantation and further survival of the embryo. Furthermore, the placenta is unique in its ability to proliferate and invade another tissue in a controlled fashion and is thus a very interesting model for the study of molecular mechanisms involved in these processes, and for differentiating them from those implicated in tumor progression.During development of the human placenta, the stem cell-like cytotrophoblast proliferates and gives rise to the differentiated syncytiotrophoblast on the villous surface and to the invasive intermediate trophoblast, which invades the maternal tissues and provides the anchoring of the placenta and the conceptus at the maternal-fetal interface. 1 The extravillous trophoblast can be further divided into proximal extravillous trophoblast originating from the anchoring villi; deep interstitial extravillous trophoblast invading the decidual stroma and the myometrium; and endovascular trophoblast, which assumes endothelial-like characteristics. [2][3][4] Starting with the initial contact which is made between the trophoblast and the apical plasma membrane of the endometrial surface epithelial cells, through the invasion of the decidua and the invasion of decidual vessels with gradual colonization of the arterial wall of the spiral arteries, cellular contacts mediated by cell adhesion molecules are of essential importance.Cell adhesion molecules are important mediators of tissue architecture and cellular polarity which also mod-