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The human endometrium undergoes to a complex series of proliferative and secretory changes in each menstrual cycle and displays only a short period of receptivity, known as the "window of implantation", necessary for the implantation of the blastocyst in the uterus.The implantation process occurs in a sequential manner, leading to the establishment of pregnancy.This fact is perhaps best illustrated with in vitro fertilization (IVF), where success rates also remain low in spite of the excellent quality of transferred embryos.This suggests that anovulation is not the only cause of infertility We conducted a search at electronic database using the following keywords: (I) "implantation", (II) "implantation AND PCOS", (III) "implantation markers", (IV) "endometrium", (V) "polycystic ovarian syndrome AND endometrium", (VI) "implantation window".The early luteal phase (day 15) is characterized by the presence of glycogen-rich secretory vacuoles below the nucleus.In the middle secretory phase, the vacuoles are located near the lumen of the glands and the nuclei are located in the basal position and there is secretion in the glandular lumen as well as stromal edema. In the late luteal phase, alterations occur in the stroma with prominent and dilated arterioles, reaching up to the surface layer and the endometrium is called pre-deciduous.This classic study is still much used for the chronological analysis of endometrial alterations; however, deficiencies have been identified.
This distribution occurs in a simplified form in the phases: proliferative (early, middle and late) and luteal or secretory phase (early, middle and late)The proliferative phase is associated with follicular growth and increased estrogen secretion, leading to endometrial reconstruction.
The initial selection of articles was based on their titles and abstracts, analyzing the full texts of those related to the subject.
A total of 105 publications were retrieved from this search, excluding repetitions, and we selected for analysis the ones considered more relevant by the authors of this review. The surface is covered with simple columnar epithelium, which is in deep contact with endometrial stroma and glandular system.
This article aims at reviewing the endometrial aspects of the "window of implantation" in women with polycystic ovary syndrome, focusing mainly on adhesion molecules.
For that purpose, we analyzed 105 articles published in journals indexed in Pub Med in the last 50 years (up to May 2011).