Current methods for assessing endometrial receptivity in in vitro fertilization: prognostic value and clinical applicability

Endometrial receptivity is a key factor in successful embryo implantation and one of the most difficult-to-assess parameters in reproductive medicine. Despite the wide range of diagnostic approaches, their clinical effectiveness remains debated. This narrative review is based on analyzing publications indexed in PubMed/MEDLINE, Scopus, and Web of Science, focusing on systematic reviews, randomized studies, as well as prospective and retrospective cohort studies aimed at evaluating endometrial receptivity in in vitro fertilization programs. The review analyzes morphological functional, molecular, and integrative approaches, and compares their clinical value regarding implantation outcomes, clinical pregnancy, and live birth. It is shown that morphological and ultrasonographic parameters are characterized by limited prognostic value and high interindividual variability. Functional methods, including assessment of blood flow and uterine peristaltic activity, demonstrate a closer relation to implantation outcomes, although their results remain heterogeneous. Molecular and cellular markers in several studies show higher diagnostic accuracy, but this not accompanied by convincingly improved live birth rates. The most studied transcriptomic tests of endometrial receptivity demonstrate no superiority compared with standard embryo transfer timing in the general patient population. Therefore, none of the existing methods has sufficient prognostic accuracy for independent clinical use. A promising approach is development of integrative diagnostic models that combine clinical, functional, and molecular parameters, followed by validation in large prospective studies.

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