By Dr. María José Iñarra Velasco (Gynaecologist – Reg. No. 202007003).
Endometrial receptivity is the endometrium’s ability to allow an embryo to adhere and implant on its surface. It is a temporary condition, influenced by multiple hormonal, immunological, and molecular factors.
When we talk about assisted reproduction, we often focus on aspects such as egg quality, sperm quality, or embryo viability. But we often forget a fundamental piece: the endometrium. This tissue that lines the inside of the uterus plays an essential role in the implantation process and, therefore, in the possibility of achieving pregnancy.
It is a mucous membrane that internally lines the uterus, and its main function is to prepare each month to receive an embryo in case fertilization occurs.
It is a tissue that is highly sensitive to hormonal changes and is constantly renewed. Therefore, if embryo implantation does not occur, the endometrium sheds and is eliminated with menstruation. When fertilization does occur, this tissue becomes the essential support for the development of pregnancy in its early stages. That is why its condition is important when trying to conceive, especially in the context of assisted reproduction.
The endometrium goes through different phases, all determined by the hormonal variations that occur each month. At the beginning of the cycle, after menstruation, the endometrium begins to regenerate under the effect of estrogens. This phase is known as the proliferative phase and is characterized by the growth of the tissue, which thickens and acquires a more organized structure.
After ovulation, progesterone takes over, and the endometrium enters the secretory phase. During this stage, the tissue becomes thicker, with a special cellular arrangement, increased vascularization, and a series of secretions that make it more suitable to host an embryo.
If pregnancy does not occur, hormone production decreases, and the endometrium sheds, resulting in menstruation.
The most common test to assess the condition of the endometrium is transvaginal ultrasound, which allows observation of its thickness and structure. A receptive endometrium is considered to have a minimum thickness of 7 millimeters and a trilaminar appearance, indicating good preparation.
In other cases, a Doppler study may be performed to assess blood flow, as good blood supply contributes to a higher probability of implantation.
When there is a history of repeated failures or suspected abnormalities, an endometrial biopsy may be indicated, taking a small tissue sample for analysis. This test can detect possible chronic inflammations, such as endometritis, which often present no symptoms but can hinder implantation, as well as immunological alterations or even microbiota imbalances.
Additionally, in recent years, the ERA test has been developed—a test that analyzes the genetic expression of the endometrium to precisely identify the moment of greatest receptivity, also known as the implantation window. This tool allows for adjusting the exact day the embryo transfer should be performed, thus increasing the chances of success.
Successful embryo implantation in the uterus is a very complex process that requires perfect synchronization between the embryo and the endometrium. It is not enough for the embryo to be of good quality. It is essential that it reaches the uterus at the moment when the endometrium is ready to receive it.
This moment is known as the implantation window and, in women with regular cycles, usually occurs between days 19 and 21 of the cycle. If the embryo transfer is performed outside this window, even if the embryo is viable, it may not implant because the uterine environment will not be adequately prepared.
That is why fertility treatments place so much emphasis on thoroughly understanding the state of the endometrium and scheduling the transfer at the optimal time.
During the implantation window, the endometrium expresses a series of genes and proteins that facilitate interaction with the embryo. Without this specific “activation,” the endometrium cannot properly fulfill its function, and implantation will not occur.
In some women, this window may be shifted or altered, meaning the usual time for transfer does not coincide with their true receptivity. That is why personalized treatment is so important, especially when there is a history of implantation failures with no apparent cause.
For this reason, in fertility treatments, it is essential to understand the state of the endometrium and its receptivity. Throughout the cycle, specialists can monitor its development with ultrasounds and hormonal checks and decide the best time to perform the embryo transfer.
Yes, in many cases, endometrial receptivity can be improved, and generally, a comprehensive approach is needed. It is very important to ensure that the response to hormonal medication is adequate and that endometrial preparation is well synchronized with embryo transfer.
Sometimes, addressing inflammation or infection can make a big difference, as can adopting healthier lifestyle habits. Maintaining a balanced lifestyle, avoiding tobacco, reducing stress, and following a nutritious diet can have a positive effect on endometrial health. There are also supplements or specific treatments that may be helpful, depending on each situation. In summary, each patient is unique, and personalizing treatment according to their needs is what can truly increase the chances of success.
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