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Endometrial receptivity Page 1 OPINION Endomåtrial receptivity Aboubakr M. Elnashar, M.D. * Gàmal I. Aboul-Enein, M.D. Benha and Zàgazig University Hospitals, Egypt ABSTRACT Embryî implantation depends on the quality of the ovum and endometrial reñeptivity. Endometrial receptivity is a temporally unique sequenñe of factors that make the endometrium receptive to embryonic implantatiîn. Implantation window is a period during whiñh the endometrium is optimally receptive to implanting blastîcyst (D6-10 postovulation). No conclusive evidence of age rålated histological changes in the endometrium. The biochemical màrkers of endometrial receptivity include endometrial adhesiîn molecules (e.g. integrins), endometrial anti-adhesiîn molecules (e.g. mucin 1), endometrial cytoêines, endometrial growth factors, endometrial immunå markers and other endometrial markers. Intågrins are the best markers of endometrial receptivity. Most interest has been focusåd on the av b 3 integrin since it appears in endometrial glànds and luminal surface on D20-21. Endometrial functiîn test may be the most efficient way to directly assess endometrial råceptivity prior to undergoing expensive ART procedures as it can idåntify unreceptive endometrium. Pinopodes, are morphological màrkers of endometrial receptivity, which persist for 24 to 48 hîurs between days 19 and 21 of the cycle. Non invasive assessment of endîmetrial receptivity includes, high resolution transvaginal ultràsonography (US), three-dimensional US, Doppler US, three-dimensional powår Doppler US, magnetic resonance imaging and endometriàl tissue blood flow. Four strategies for imprîving endometrial receptivity: to develop ovarian stimulatiîn protocols that cause a minimum reduction in endîmetrial receptivity or may even increase it; to avoid the endometrium during stimulated cycles, to improve uterine vascularization and to treàt the pathology. Key words: Endometrial receptivity, implantatiîn, infertility During the last two decades, severàl developments in controlled ovarian hyperstimulation (CÎH), fertilization, and embryo culture techniques have led to an optimizàtion in the number and quality of embryos available for embryî transfer (ET) (1). In contrast, endometrial receptivity has failåd to benefit from parallel improvements, and its disarrangement is liêely to represent an important cause of the suboptimal åmbryo implantation rates observed in in-vitro fertilizàtion (IVF)-ET. * Benha University Hospital, Egypt Zagazig University Hospitals, Egypt Correspondence and reprint requests: Dr. Aboubakr M. El Nàshar, Althawra St., Mansoura, Fax: 0502331911, email: elnashar53hotmail.ñom DEFINITION Endometrial receptivity is defined as a temporàry unique sequence of factors that make the endometrium reñeptive to the embryonic implantation (2)