Molecular markers of implantation: clinical implications

The endometrium has been conventionally studied using histologic criteria. Our understanding of endometrial physiology has been advanced tremendously by research into the molecules that mediate its development and function. T hese molecules demonstrate a dynamic expression pattern through the menstru al cycle and have been implicated in endometrial growth, differentiation, a nd receptivity. These molecules include secreted proteins (endometrial blee ding-associated factor, glycodelin-A, insulin-like growth factor binding pr otein-1), cell-surface receptors (integrins), and nuclear transcription fac tors (HOXA10 and HOXA11). The homeobox genes Hoxa10 and Hoxa 11 are necessa ry for implantation because mice with mutations in these genes exhibit a fa ilure of implantation. HOXA10 and HOXA11 have been shown to be important fo r implantation in humans as well. Knowledge of endometrial molecular dynami cs may now be used to enhance our ability to diagnose implantation defects. It may soon be possible to treat individual molecular defects by protein s upplementation or gene therapy. Curr Opin Obstet Gynecol 13:269-274. (C) 20 07 Lippincott Williams & Wilkins.