Endometrial dysfunction in embryo implantation: from molecular mechanisms to clinical management

Endometrial dysfunction represents a central pathological factor underlying recurrent implantation failure and infertility. This review provides a comprehensive synthesis of the physiological basis of endometrial function, the pathological factors compromising its integrity, and the impact of these abnormalities on embryo implantation. Key pathogenic drivers, including cellular senescence, chronic inflammation, iatrogenic injury, endometriosis, and microbiome dysbiosis, converge on common mechanistic pathways such as decidualization impairment, immune dysregulation, epigenetic alterations, and mechanosensing defects. Building upon this mechanistic framework, we summarize current therapeutic interventions based on published literature. Available evidence suggests that intrauterine platelet-rich plasma (PRP) infusion appears promising among evaluated adjunctive interventions, but its definitive clinical superiority remains to be confirmed in large, standardized, head-to-head randomized trials. Granulocyte colony-stimulating factor (G-CSF), peripheral blood mononuclear cells (PBMCs), growth hormone, and stem cell-based therapies also show therapeutic potential but require further validation through well-designed studies. This review provides a theoretical foundation for understanding the association between endometrial dysfunction and embryo implantation failure and offers a practical, evidence-informed reference for personalized clinical treatment strategies.