ABSTRACT
The widespread adoption of unproven empirical treatments that aim to improve endometrial receptivity after in vitro fertilization (IVF) treatment says much about the challenges that clinicians face as they seek to help patients struggling to conceive. This chapter describes the methods aimed at increasing endometrial blood flow: nitric oxide (NO) donors, aspirin and heparin. It discusses the methods aimed at modulating immune response: glucocorticoids and endometrial injury. Recent developments in understanding of the molecular regulation of endometrial receptivity and in techniques for interrogating the endometrium at a molecular level are offering novel insights into the role of the endometrium in determining whether implantation is successful. Interventions aimed at improving receptivity may do so at the cost of an increased risk of subsequent clinical miscarriage, and it is noteworthy that while a number of studies of empirical therapies appear to increase pregnancy rates, these do not appear to be translated to an impact on live birth rates.
