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PURPOSE OF REVIEW Embryo implantation remains the rate-limiting step in assisted conception programmes. Factors affecting the interactions between blastocyst and endometrium are subjects of current research and, sadly, have also been the subjects of much confusion. This review aims to present current thinking on factors affecting embryo development, endometrial receptivity during and around the implantation window and the evidence for and against various proposed treatment options RECENT FINDINGS Age-related aneuploidies of the sex chromosomes and several other autosomes are now thought to adversely affect oocyte and embryo quality, leading to repeat in-vitro fertilization failures. Several small controlled trials have suggested improvements in clinical outcomes following preimplantation screening and blastocyst transfer for aneuploidy in older women. These are, however, very costly, wasteful of embryos and do not appear beneficial after the age of 40 years. Factors influencing endometrial receptivity remain largely unresolved. New technology using microarrays for gene expression profiling and progesterone receptor polymorphism may shed more light in the near future. SUMMARY Giant strides have been made in studying the causative factors of implantation failure, but these have not been matched by therapeutic solutions. Many proposed interventions are of unproven value, yet can have harmful side-effects.

The utility of using psychological assessments as a basis for predicting pain relief after electrode implantation is examined. Two raters independently reviewed the functional pain protocols of chronic pain patients who were candidates for deep brain (n = 13) or spinal cord (n = 17) electrode implants and predicted whether each would have a good or poor treatment response. At follow-up, five deep brain (39%) and four spinal cord (24%) patients were classified as having good responses to treatment. Predictions of outcome based on psychological data were accurate for 80% of the patients. These results suggest that functional pain assessment is useful as a part of preimplantation screening and emphasize the importance of psychological factors in the outcome of treatment for chronic pain.