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Determinants of Embryo Implantation: Roles of the Endometrium and Embryo in Implantation Success

  • Infertility: Review
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Abstract

Both uterine endometrium and embryo contribute to implantation success. However, their relative role in the implantation success is still a matter for debate, as are the roles of endometrial receptivity analysis (ERA), endometrial scratch (ES), endometrial microbiome, and intrauterine or intravenous measures that are currently advocated to improve the implantation success. There is insufficient evidence to suggest that the endometrium is more important than the embryo in determining the implantation success and the utility of these measures, especially when euploid embryos are transferred is limited. Although embryo implantation on epithelium other than the endometrium is a very rare event, evidence suggests that embryo implantation and growth is not limited to the endometrium alone. Embryos can implant and develop to result in livebirths on epithelium that lacks the typical endometrial development present at implantation. Currently, the role of embryo euploidy in implantation success is underappreciated. At a minimum, it is the author’s opinion that until robust, definitive studies are conducted that demonstrate benefit, reproductive endocrinologists and infertility specialist should be prudent in the way they counsel patients about the utility of ERA, ES, and other measures in improving implantation success.

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Authors and Affiliations

  1. Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA

    Awoniyi O. Awonuga, Olivia G. Camp, Husam M. Abu-Soud, Daniel A. Rappolee & Elizabeth E. Puscheck

  2. Kindbody Fertility, 26400 W 12 Mile Road, Ste. 140D, Southfield, MI, 48034, USA

    Awoniyi O. Awonuga

  3. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 26400 West 12 Mile Road, Suite 140, Southfield, MI, 48034, USA

    Awoniyi O. Awonuga

  4. Department of Physiology, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA

    Husam M. Abu-Soud & Daniel A. Rappolee

  5. Reproductive Stress, Inc., 135 Lake Shore Rd, Grosse Pointe Farms, MI, USA

    Daniel A. Rappolee & Elizabeth E. Puscheck

  6. InVia Fertility, 2718 W Roscoe St Suite 500, Chicago, IL, 60618, USA

    Elizabeth E. Puscheck

  7. InVia Fertility, 1585 N. Barrington Road, Suite 406, Doctor’s Building Two, Hoffman Estates, IL, 60169, USA

    Elizabeth E. Puscheck

  8. Department of Obstetrics and Gynecology, Augusta University, 1120 15Th Street, CJ‑1036, Augusta, GA, 30912, USA

    Michael P. Diamond

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The first draft of the manuscript was conceptualized and written by Awoniyi Awonuga, and all authors critically revised the work. An extensive literature search was conducted and contributed to by all authors. All authors read and approved the final manuscript.

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Awonuga, A.O., Camp, O.G., Abu-Soud, H.M. et al. Determinants of Embryo Implantation: Roles of the Endometrium and Embryo in Implantation Success. Reprod. Sci. 30, 2339–2348 (2023). https://doi.org/10.1007/s43032-023-01224-w

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