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Causes of Infertility

Uterine Receptivity

A successful pregnancy requires that the embryo attach to the lining of the uterus (endometrium), where it will develop. There is only a narrow window of implantation during the menstrual cycle when the uterus is receptive for an embryo to establish a pregnancy.

To evaluate uterine receptivity, we measure blood levels of progesterone around cycle day 21. Elevated levels of progesterone have been associated with normal corpus luteum function, and by inference, normal uterine receptivity.

Dr. Castelbaum and colleagues have published many of the landmark studies using endometrial integrins, important markers of uterine receptivity. One marker, the avb3 endometrial integrin, has been extensively studied. It abruptly appears in the lining of the uterus on cycle day 20, at the optimal time for implantation. Understanding what regulates endometrial integrins may lead to better treatment and diagnostic strategies for infertility.

Many causes of infertility result in diminished uterine receptivity, including minimal and mild endometriosis, blocked and dilated fallopian tubes, unexplained infertility and polycystic ovarian disease. Women experiencing recurrent miscarriage may also have decreased uterine receptivity. Interestingly, when blockages in the fallopian tubes are removed prior to in vitro fertilization, normal uterine receptivity is restored. It is our practice to offer this procedure, prior to IVF, to women with dilated fallopian tubes.

Women who do not ovulate due to polycystic ovarian disease, hypothalamic amenorrhea and premature menopause can be easily treated with medications to create a receptive endometrium. This is critically important for successful frozen embryo transfers and for women using donor eggs.

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