Endometrial receptivity in the eutopic endometrium of women with endometriosis: it is affected, and let me show you why
Open accessAbstract
The endometrium maintains complex controls on proliferation and apoptosis as part of repetitive menstrual cycles that prepare the endometrium for the window of implantation and pregnancy. The reliance on inflammatory mechanisms for both implantation and menstruation creates the opportunity in the setting of endometriosis for establishment of chronic inflammation that is disruptive to endometrial receptivity, causing both infertility and abnormal bleeding. Clinically, there can be little doubt that the endometrium of women with endometriosis is less receptive to embryo implantation, and strong evidence exists to suggest that endometrial changes are associated with decreased cycle fecundity as a result of this disease. Here we provide unifying concepts regarding those changes and how they are coordinated to promote progesterone resistance and estrogen dominance through aberrant cell signaling pathways and reduced expression of key homeostatic proteins in eutopic endometrium of women with endometriosis.
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The endometrium shows several abnormalities in women with endometriosis, resulting in reduced endometrial receptivity and a lower embryo implantation rate.
“The endometrium, according to multiple authors, shows several abnormalities in women with endometriosis, resulting in reduced endometrial receptivity and a lower embryo implantation rate (Lessey and Kim, 2017”
From IVF/ICSI or surgery as first approach for the treatment of infertility associated with ovarian and deep infiltrating endometriosis? A systematic review and meta-analysis. (2026) · cites this paper as Lessey and Kim, 2017
Endometrial chronic inflammation, together with progesterone resistance, estrogen dominance, aberrant cell signaling pathways and reduced expression of key homeostatic proteins in women with endometriosis, are disruptive to endometrial receptivity.
“The endometrial chronic inflammation, together with progesterone resistance, estrogen dominance, aberrant cell signaling pathways and reduced expression of key homeostatic proteins in women with endometriosis, are disruptive to endometrial receptivity [158].”
From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [158]
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- Authors
- Lessey, B. A., & Kim, J. J.
- Affiliations
- Prisma Health (US)
- Northwestern University (US)
- Corresponding author
- Lessey, Bruce A.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 108
- Issue
- 1
- Pages
- 19-27
- ISSN
- 0015-0282 (ISSN-L)
- PMC
- PMC5629018
- OpenAlex
- W2624413373
- Cited by
- 286
- References
- 167
- Citations by year
- 2026: 29 · 2025: 26 · 2024: 33 · 2023: 41 · 2022: 41 · 2021: 38 · 2020: 42 · 2019: 20 · 2018: 11 · 2017: 4
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD067721)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- endometriosis, endometrial receptivity, eutopic endometrium, embryo implantation, chronic inflammation, infertility, abnormal uterine bleeding, progesterone resistance, estrogen dominance, signaling pathways, menstrual cycle
- MeSH terms
- Animals, Embryo Transfer, Endometriosis, Endometrium, Female, Fertilization in Vitro, Humans, Infertility, Female, Menstrual Cycle, Embryo Implantation, Pregnancy, Recurrence, Species Specificity, Treatment Failure, Models, Immunological, Evidence-Based Medicine, Transcriptome
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