Endometrial support beyond hormones

Abstract

Implantation is a very complex process, which is controlled by a number of molecules like hormones, cytokines and growth factors and their crosstalk. During the implantation period, the endometrium acquires an appropriate morphological and functional state under the influence of ovarian steroids and molecular mediators. Assisted reproductive technology protocols continue to evolve with the aim of achieving higher pregnancy rates; however, despite these advances, implantation rates are still relatively low and have not increased sufficiently in the last decade to allow widespread adoption of single-embryo transfer. A number of empirical treatment modalities have been tried but with limited success rates, since the pathological processes are poorly understood. Endometrial stem cells and gene therapy are promising options that can be effective in the future. Use of new tissue profiling technologies at genomic, transcriptomic and proteomic levels will bring new strategies in treating implantation failure and help increase successful pregnancies. This chapter aims to summarize the current knowledge of the mechanism of implantation, molecular and morphological markers of endometrial receptivity and proposed treatment options to improve implantation rate.