Endometrial immune profiling: Bridging pre-eclampsia research with infertility solutions

Assisted reproductive technologies (ART) are now widely recognized as a key therapeutic option for individuals experiencing infertility. Despite these technological improvements, ART success rates remain suboptimal. One emerging area of interest is the endometrial immune profiling, which involves the characterization of endometrial immune cells and biomarkers to assess local immunological conditions that may influence implantation and pregnancy outcomes before conception. In this review, we will discuss how the endometrial biomarkers selected prior to pregnancy to characterize the immune environment during the implantation window are directly linked to some immune key factors known to be crucial in the human placentation. Strong published evidence demonstrates that physiological transformation with remodeling of the uteroplacental spiral arteries is a key player to successful placentation and normal placental function. Poor remodeling of the uteroplacental spiral arteries, therefore, is associated with early-onset preeclampsia (PE) and several other major obstetrical syndromes, including fetal growth restriction, placental abruption, and spontaneous preterm premature rupture of membranes. In the future, endometrial immune profiling prior to conception could serve as a valuable indicator to predict high obstetrical risk and/or prevent some pregnancy-related pathology based on a better understanding of the underlying mechanisms.