Metabolic Reprogramming in Endometrium During Menstrual Cycle and Its Relationship to Infertility

The human endometrium, a complex and dynamic tissue, experiences cyclical shedding, repair, regeneration, and modification in anticipation of embryo implantation. During the mid-secretory phase, influenced by ovarian steroid hormones, it becomes briefly receptive. The functional layer of the endometrium, consisting of several cell types including epithelial, stromal, vascular, and immunological cells, is essential for reproduction as it prepares for implantation, sustains pregnancy, and enables menstruation. Progesterone generated during the secretory phase prepares the endometrium for blastocyst implantation. Decidualization, an essential component of endometrial remodeling, entails substantial cellular alterations vital for successful implantation. Metabolic reprogramming in the endometrium entails critical alterations in metabolic enzymes, metabolites, and pathways in reaction to environmental stimuli. Decidualization requires significant energy, leading to a major transformation in energy metabolism. This includes modifications in carbohydrate, lipid, and amino acid metabolism that support the development of decidual cells.