Recent Advances and Current Perspectives on Endometrial Receptivity

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.