Selected pathological conditions affecting endometrial receptivity

Authors: L. Mekiňová 1 ;  M Ješeta 1 ;  I. Crha 1,2 ;  K. Crha 1 ;  J. Vodička 3 ;  R. Hudeček 1 ;  K. Remundová 1 ;  E. Matušková 1 ;  R. Pilka 3
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN Brno 1;  Ústav zdravotnických věd, LF MU Brno 2;  Porodnicko-gynekologická klinika LF UP a FN Olomouc 3
Published in: Ceska Gynekol 2022; 87(6): 416-422
Category: Review Article
doi: 10.48095/cccg2022416


Objective: A summary of new knowledge on embryo implantation in dependence on quality of the endometrium. Methods: Literature review from August 2022 of the relevant publications in Web of Science, Scopus and PubMed/Medline databases, focused on “endometrial receptivity”, “polycystic ovary syndrome”, “endometriosis”, “SARS-CoV-2”. Results: The receptive state of the endometrium is a result of physiological remodeling and immune system activity modulated by the microbio­me. This balance can be disturbed by myomas, polyps, sactosalpings, adenomyosis, endometriosis, polycystic ovary syndrome, infections. The effect of SARS-CoV-2 infection is being discussed. For a successful implantation, timing of transfer is crucial. The ultrasound examination is used conventionally. In specific cases, hysteroscopy and endometrium bio­psy are recommended. Histological and immunohistochemical evaluation is performed together with examination of microbio­me or transcriptome. To support the implantation, gestagenes are used, or metformin in the patients with polycystic ovary syndrome. In cases of a repeated implantation failure, the intrauterine infusion of mononuclear cells or platelet rich plasma is used, subcutaneous application of granulocyte colony stimulating growth factor, intravenous application of atosiban or intrauterine application of human chorionic gonadotropin. Conclusion: Recent research in the field of transcriptomics, proteomics and reproductive immunology uncovers the process of implantation more deeply and opens a new stage of the assisted reproduction.


Endometriosis – adenomyosis – SARS-CoV-2 – proteome – implantation – receptivity of endometrium – polycystic ovaries – secretome


1. Craciunas L, Gallos I, Chu J et al. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum Reprod Update 2019; 25 (2): 202–223. doi: 10.1093/humupd/dmy044.

2. Crha I, Ventruba P, Ješeta M et al. Děložní mikrobio­m jako faktor receptivy endometria. Ceska Gynekol 2019; 84 (1): 49–54.

3. Busnelli A, Somigliana E, Cirillo F et al. Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta analysis. Sci Rep 2021; 11 (1): 1747. doi: 10.1038/s41598-021-81439-6.

4. He A, Zou Y, Wan C et al. The role of transcriptomic bio­markers of endometrial receptivity in personalized embryo transfer for patients with repeated implantation failure. J Transl Med 2021; 19 (1): 176. doi: 10.1186/s12967-021-02837-y.

5. Díaz-Gimeno P, Horcajadas JA, Martínez--Conejero JA et al. A genomic dia­gnostic tool for human endometrial receptivity based on the transcriptomic signature. Fertil Steril 2011; 95 (1): 50–60. doi: 10.1016/j.fertnstert.2010.04.063.

6. Haouzi D, Entezami F, Torre A et al. Customized frozen embryo transfer after identification of the receptivity window with a transcriptomic approach improves the implantation and live birth rates in patients with repeated implantation failure. Reprod Sci 2021; 28 (1): 69–78. doi: 10.1007/s43032-020-00252-0.

7. Ulčová-Gallová Z, Pešek M, Chaloupka P et al. Screeningové vyšetření endometriálních NK buněk u vybraných infertilních pacientek 1. část – metodika a průběžné výsledky. Ceska Gynekol 2017; 82 (5): 366–371.

8. Sehring J, Beltsos A, Jeelani R. Human implantation: the complex interplay between endometrial receptivity, inflammation, and the microbio­me. Placenta 2022; 117: 179–186. doi: 10.1016/j.placenta.2021.12.015.

9. Dvořan M, Vodička J, Dostál J et al. Implantace a dia­gnostika receptivity endometria. Ceska Gynekol 2018; 83 (4): 291–299.

10. Liu A, Raja Xavier J, Singh Y et al. Molecular and physiological aspects of SARS-CoV-2 infection in women and pregnancy. Front Glob Womens Health 2022; 3: 756362. doi: 10.3389/ fgwh.2022.756362.

11. Vallvé-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis. Hum Reprod Update 2019; 25 (5): 564–591. doi: 10.1093/ humupd/ dmz018.

12. Bai X, Zheng L, Li D et al. Research progress of endometrial receptivity in patients with poly­cystic ovary syndrome: a systematic review. Reprod Biol Endocrinol 2021; 19 (1): 122. doi: 10.1186/s12958-021-00802-4.

13. Qiong Z, Jie H, Yonggang W et al. Clinical validation of pinopode as a marker of endometrial receptivity: a randomized controlled trial. Fertil Steril 2017; 108 (3): 513.e2–517.e2. doi: 10.1016/j.fertnstert.2017.07.006.

14. Zeng H, Fu Y, Shen L et al. MicroRNA signatures in plasma and plasma exosome during window of implantation for implantation failure following in-vitro fertilization and embryo transfer. Reprod Biol Endocrinol 2021; 19 (1): 180. doi: 10.1186/s12958-021-00855-5.

15. Chen CH, Lu F, Yang WJ et al. A novel platform for discovery of differentially expressed microRNAs in patients with repeated implantation failure. Fertil Steril 2021; 116 (1): 181–188. doi: 10.1016/j.fertnstert.2021.01.055.

16. Benner M, Ferwerda G, Jossten I et al. How uterine microbio­ta might be responsible for a receptive, fertile endometrium. Hum Reprod Update 2018; 24 (4): 393–415. doi: 10.1093/humupd/ dmy012.

17. Crha K, Ješeta M, Pilka R et al. Adeno­myóza – možný vliv na funkci a receptivitu endometria. Ceska Gynekol 2021; 86 (3): 205–209. doi: 10.48095/cccg2021205.

18. Ulčová-Gallová Z, Cibulka J, Lošan P. Antifosfolipidové protilátky a infekce covidem-19 u žen se sníženou plodností. Ceska Gynekol 2021; 86 (3): 210–213. doi: 10.48095/cccg2021210.

19. Daumová M, Hadravská Š, Straková Peteříková A et al. SARS-CoV-2 placentitida – popis dvou případů a přehled literatury. Ceska Gynekol 2022; 87 (2): 111–117. doi: 10.48095/ cccg2022111.

20. Jafari M, Pormohammad A, Sheikh Neshin SA et al. Clinical characteristics and outcomes of pregnant women with COVID‐19 and comparison with control patients: a systematic review and meta‐analysis. Rev Med Virol 2021; 31 (5): 1–16. doi: 10.1002/rmv.2208.

21. Balachandren N, Davies MC, Hall JA et al. SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3,041 pregnancies conceived during the pandemic. Hum Reprod 2022; 37 (6): 1126–1133. doi: 10.1093/ humrep/deac062.

22. Hudecek R, Kohlova B, Siskova I et al. Blocking of EphA2 on endometrial tumor cells reduces susceptibility to Vd1 gamma-deltaT-cell-mediated killing. Front Immunol 2021; 12: 752646. doi: 10.3389/fimmu.2021.752646.

23. Teede HJ, Misso ML, Costello MF at al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33 (9): 1602–1618. doi: 10.1093/humrep/dey256.

24. Palioura E, Diamanti-Kandarakis E. Polycystic ovary syndrome (PCOS) and endocrine disrupting chemicals (EDCs). Rev Endocr Metab Disord 2015; 16 (4): 365–371. doi: 10.1007/s11154- 016-9326-7.

25. Youngster M, Avraham S, Yaakov O et al. IVF under COVID-19: treatment outcomes of fresh ART cycles. Hum Reprod 2022; 37 (5): 947–953. doi: 10.1093/humrep/deac043.

26. Salem D, Katranji F, Bakdash T et al. COVID-19 infection in pregnant women: review of maternal and fetal outcomes. Int J Gynecol Obstet 2021; 152 (3): 291–298. doi: 10.1002/ijgo.13533.

27. Madar J, Ulčová-Gallová Z et al. Imunologie a imunopatologie lidské reprodukce: vybrané kapitoly. 2nd ed. Praha: Mladá fronta 2020: 1–152.

28. Henarejos-Castillo I, Sebastian-Leon P, Devesa-Peiro A et al. SARS-CoV-2 infection risk assessment in the endometrium: viral infection-related gene expression across the menstrual cycle. Fertil Steril 2020; 114 (2): 223–232. doi: 10.1016/j.fertnstert.2020.06.026.

29. Liu Z, Liu X, Wang M et al. The clinical efficacy of personalized embryo transfer guided by the endometrial receptivity array/analysis on IVF/ICSI outcomes: a systematic review and meta-analysis. Front Physiol 2022; 13: 841437. doi: 10.3389/fphys.2022.841437.

30. Messaoudi S, EL Kasmi I, Bourdiec A et al. 15 years of transcriptomic analysis on endometrial receptivity: what have we learnt? Fertil Res Pract 2019; 5: 9. doi: 10.1186/s40738-019-0059-7.

31. Mizrachi Y, Weissman A, Rozen G et al. Timing of progesterone luteal support in natural cryopreserved embryo transfer cycles: back to basics. Reprod Biomed Online 2022; 45 (1):  63–68. doi: 10.1016/j.rbmo.2022.03.021.

32. Vodička J, Dvořan M, Smékalová K et al. Možnosti přípravy endometria ke kryoembryotransferu. Ceska Gynekol 2018; 83 (1):  24–28.

33. Gao MX, Jiang XY, Li B et al. Intrauterine injection of humanchorionic gonadotropin before embryo transfer can improve in vitro fertilization-embryo transfer outcomes: a meta-analysis of randomized controlled trials. Fertil Steril 2019; 112 (1): 89–97. doi: 10.1016/j.fertnstert.2019.02.027.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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