Eutopic Endometrium in Women with Endometriosis: Ground Zero for the Study of Implantation Defects

Abstract

The endometrium is ground zero when it comes to understanding how implantation occurs and how it might also fail, resulting in infertility or pregnancy loss. Many of the causes of diminished uterine receptivity are acquired during a woman's lifetime. Endometriosis, a major inflammatory disease affecting women, is also a leading cause of infertility and miscarriage. Once established, the inflammatory changes can, in some women, lead to progesterone resistance and downstream changes in endometrial gene expression. Much is now known about how inflammation translates to progesterone resistance and infertility, but much remains to be learned. In this review we provide an overview for understanding how the endometrium becomes dysfunctional, what biomarkers may hold promise for the diagnosis of endometriosis, and how progesterone resistance leads to infertility. Understanding the pathophysiology of this disease will likely lead to better treatment options.

Molecular and preclinical basis to inhibit PGE 2 receptors EP2 and EP4 as a novel nonsteroidal therapy for endometriosis

“…In women with endometriosis, the microenvironment of the endometrium becomes proinflammatory, E 2 -dominant, and P 4 -resistant, and thereby impairs receptivity for establishment of pregnancy (1,2,26,27). The endometrium first becomes hyperresponsive to E 2 and then resistant to P 4 (1,16,28).…”

Physiological and pathological implications of retinoid action in the endometrium

“…4). With respect to eutopic endometrial function in endometriosis, impaired RA signaling can be an attributed to dysfunctional stromal differentiation, leading to the reduced capacity for decidualization reported in these cases (Klemmt et al 2006, Aghajanova et al 2009, Lessey et al 2013.…”

Endometriosis and Implantation Failure: Review

“…23,[34][35][36] Bunun dı-şında endometriyozlu hastalarda implantasyon biyomarkerlarından osteopontinin geç sekretuar fazda azalması, apolipoprotein E ve apolipoprotein A1'in sekretuar fazda artmış olması muhtemel implantasyon sorunlarına yol açabilir.…”

“…Endometriyumdaki bu geniş hücre tipi trafiği endometriyal reseptivitenin sağlanma-sında kritik rol oynayabilir. 23 Sonuç olarak; endometriyozda kötü YÜT sonuçlarında en önemli sebep oosit gibi görünürken endometriyal reseptivite disfonksiyonu onu izleyen ikinci önemli sebep olarak görünmektedir. Ancak; ötopik endometriyumun endometriyozda nasıl disfonksiyone olduğu tam olarak aydınlatılamamıştır.…”