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Androgens and endometrium: new lessons from the corpus luteum via the adrenal cortex?

      As has been clearly demonstrated in ovum donation cycles, endometrial receptivity to embryo implantation is determined by the duration of exposure to progesterone, the primary secretion of the corpus luteum. During the luteal phase, progesterone alone can provide normal structural and cellular changes, with the absolute necessity of additional estradiol an open question (
      • Young S.L.
      Oestrogen and progesterone action on endometrium: a translational approach to understanding endometrial receptivity.
      ). Thus, provision of enough progesterone (plus, perhaps, estradiol) is sufficient for normal, human, secretory phase endometrial structure and function. On the other hand, evolution has given us a corpus luteum that secretes many products in addition to estradiol and progesterone and it seems un likely that they are all vestigial or unrelated to pregnancy initiation and maintenance. Further, clinical pregnancy results from transfer of a euploid blastocyst into a progesterone prepared endometrium in women only about 50%-60% of the time, suggesting strong potential for other factors to improve endometrial function.
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