Endometrial function: cell specific changes in the uterine environment.

The uterus undergoes dynamic changes during the cycle and these events are largely driven by ovarian steroids. However, in the presence of an embryo, an additional series of changes that are not otherwise observed predominate. The ability of the embryo to modulate the uterine environment is restricted to a specific time of the cycle which is termed the 'window of receptivity'. Changes that occur within this window of receptivity and immediately following implantation can be divided into three distinct phases. The first phase, regulated by estrogen and progesterone, is characterized primarily by changes in both the luminal and glandular epithelial cells in preparation for blastocyst apposition and attachment. If the action of progesterone is antagonized, these changes are inhibited and the uterus is maintained in a pre-receptive state. The second phase is in the further modulation of these steroids induced changes by embryonic signals. In the primate, infusion of chorionic gonadotropin in a manner that mimics blastocyst transit, results in the endoreplication and plaque formation in the luminal epithelium. The glandular epithelium responds by increasing transcriptional and post-translational modifications of secretory proteins and the stromal fibroblasts initiate their differentiation process into a decidual phenotype. The final phase is associated with trophoblast invasion and remodeling of the endometrial stromal compartment. The most dramatic effect is on the stromal fibroblasts, which in response to embryonic stimuli, differentiate into decidual cells, the major cell type of the gestational endometrium. Thus, during the window of receptivity, signals from the embryo can dramatically alter the morphological and functional characteristics of the uterine endometrium. We suggest that these changes are critical to ensure prolonged maintenance of endometrial function during gestation and facilitate trophoblast invasion.