Recent Advances and Current Perspectives on Endometrial Receptivity
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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