Abstract
Infertility is a common problem in modern societies with significant socio-psychological implications for women. Therapeutic interventions are often needed which, depending on the cause, can either be medical treatment, surgical procedures or assisted reproductive technology (ART). However, the treatment of infertility is not always successful due to our limited understanding of the preparation of the lining of the uterus, the endometrium, for pregnancy. The endometrium is of central importance for successful reproduction as it is the site of placental implantation providing the interface between the mother and her baby. Due to the dynamic, structural and functional changes the endometrium undergoes throughout the menstrual cycle, it is challenging to study. A major advancement is the establishment of 3D organoid models of the human endometrium to study this dynamic tissue in health and disease. In this review, we describe the changes that the human endometrium undergoes through the different phases of the menstrual cycle in preparation for pregnancy. We discuss defects in the processes of endometrial repair, decidualization and acquisition of receptivity that are associated with infertility. Organoids could be utilized to investigate the underlying cellular and molecular mechanisms occurring in non-pregnant endometrium and early pregnancy. These studies may lead to therapeutic applications that could transform the treatment of reproductive failure.
Highlights
The World Health Organization describes infertility as a ‘disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse’ (Zegers-Hochschild et al 2017)
Primary infertility of female origin is attributed to hormonal, functional or anatomical dysfunction of the organs of the reproductive tract. It is a complex disorder with a range of contributing factors including systemic diseases, environmental and lifestyle influences that can affect reproductive function (Vander Borght & Wyns 2018)
We describe the functional and morphological changes of the endometrium during the menstrual cycle and in pregnancy
Summary
The World Health Organization describes infertility as a ‘disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse’ (Zegers-Hochschild et al 2017). There are new methods to co-culture endometrial organoids with stromal cells in a collagen scaffold providing opportunities for in vitro modelling of the endometrium to study stromal–epithelial interactions driving decidualization (Abbas et al 2020) (Fig. 3).
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