Alteration in Endometrial Remodeling: A Cause for Implantation Failure in Endometriosis?

K. Saikat, Priyanka Banerjee, Shyam Thangaraju, Baidyanath Chakravarty, Koel Chaudhury
In: Endometriosis - Basic Concepts and Current Research Trends · 2012 · doi:10.5772/30687 · W1521311468
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This review examines how endometriosis disrupts endometrial remodeling and receptivity during the implantation window, proposing that defective endometrial-embryonic crosstalk contributes to implantation failure and the 3-4 fold reduction in fertility seen even in mild disease.

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This chapter reviews the molecular mechanisms underlying endometrial remodeling to determine if defects in this process contribute to implantation failure in patients with endometriosis. It examines how inflammatory mediators, cytokines, and adhesion molecules are dysregulated in the eutopic endometrium of affected women, leading to impaired decidualization and altered expression of integrins and leukemia inhibitory factor. The authors propose that these molecular abnormalities prevent successful embryo attachment and subsequent pregnancy maintenance. This paper is centrally about endometriosis — specifically investigating the link between defective endometrial receptivity and infertility associated with the condition.

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Abstract

The process of implantation is an interactive cascade of events between the embryo and the endometrium. It is a dynamic process consisting of three distinct phases. They are (i) apposition of embryo (ii) attachment with the epithelial lining of the endometrium and (iii) invasion into the endometrial stroma gaining access to the maternal circulatory system. Embryo implantation failure may occur due to embryonic defect or unsupportive endometrium. Advances in Assisted Reproductive Technology (ART) have made it possible to obtain good quality embryos; however, successful implantation remains the bottleneck for a successful pregnancy. The endometrium remodels before attaining a state of receptivity. Endometrium remains receptive during a limited period, when it is favourable for blastocyst attachment and implantation. In women, there is clinical evidence of a brief period of optimal uterine receptivity which allows for blastocyst implantation. This period, called the implantation window, is related to changes in the endometrial epithelial morphology. Inappropriate morphological development leads to unreceptive endometrium that causes defective endometrial /embryonic cross talk. This is generally agreed to be one of the main reasons for implantation failure. Endometriosis, characterized by benign growth of endometrial tissue outside the uterus, affects approximately 20%–48% of women during their reproductive years. The occurrence of aberrant hormonal, immunological, genetic and pathophysiological events associated with endometriosis is attributed to the heterogeneous etiology of the disease. The symptoms of endometriosis do not depend on the severity or stage of the disease. Women with even mildest degree of endometriosis can have a 3 – 4 fold reduction in their annual birth rate compared to normal non-endometriotic women.
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Open access Submitted: 22 March 2011 Published: 09 May 2012 DOI: 10.5772/30687 From the Edited Volume Edited by Koel Chaudhury and Baidyanath Chakravarty Submitted: 22 March 2011 Published: 09 May 2012 © 2012 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Discover 2026 Nobel Laureate Francis Halzen’s chapter on IntechOpen >

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