Recent Advances and Current Perspectives on Endometrial Receptivity

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This review updates understanding of endometrial receptivity, discussing molecular mechanisms, controversial diagnostic tests, and the impact of gynecologic conditions on fertility and ART success.

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This review summarizes current understanding of endometrial receptivity, including molecular mechanisms underlying the estrogen–progesterone transition and evidence for commercially available molecular tests (Endometrial Function Test, Endometrial Receptivity Assay, and ReceptivaDx/ERA) that aim to assess receptivity for ART decisions. It reports that although pathologic conditions such as polyps, fibroids, adenomyosis, and chronic endometritis can impair implantation through effects on embryo transport/attachment and/or receptivity, the exact molecular transition from non-receptive to receptive endometrium remains poorly defined. A key limitation noted is that existing evidence is insufficient to support routine clinical use of these commercially available tests, and heterogeneity in genetic and molecular signatures across conditions complicates development of targeted molecular testing. This paper is centrally about endometriosis — it reviews how common conditions including adenomyosis and other endometrial pathologies may affect implantation and ART outcomes, and it also highlights endometriosis-associated work on receptivity biomarkers like BCL6 and progesterone resistance.

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Abstract

Purpose of Review The purpose of this review is to update readers on our current understanding of endometrial receptivity and to review the literature regarding endometrial assessment and pathologic states which may influence receptivity. Recent Findings Topics discussed include molecular mechanisms implicated in endometrial receptivity on the basis of which three commercially available yet controversial tests have been developed (Endometrial Function Test, Endometrial Receptivity Assay, and ReceptivaDx), as well as current evidence surrounding how common gynecologic conditions such as polyps, fibroids, adenomyosis, and chronic endometritis may influence endometrial receptivity and the success of assisted reproductive technologies (ART). Summary While the sequential action of estrogen and progesterone is central to the development of endometrial receptivity, the exact molecular mechanisms governing the transition from non-receptive to receptive endometrium remain poorly understood. Commercially available tests attempt to harness molecular markers to assess and potentially improve endometrial receptivity; however, current evidence is insufficient to support their routine clinical application. Polyps, fibroids, adenomyosis, and chronic endometritis may negatively impact implantation either directly by impeding embryo transport and attachment or indirectly by influencing endometrial receptivity. Given the likely heterogenous genetic construct and molecular expression of any pathologic condition, further research is needed to develop molecular testing to guide approach to clinical treatment. Similar content being viewed by others

References

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Human and Animal Rights and Informed Consent This article does not contain and studies with human or animal subjects performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Bakkensen, J.B., Agarwal, R. & Shapiro, M. Recent Advances and Current Perspectives on Endometrial Receptivity. Curr Obstet Gynecol Rep 10, 45–52 (2021). https://doi.org/10.1007/s13669-021-00313-4 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13669-021-00313-4

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