子宮內膜異位症，多囊性卵巢影響子宮內膜基因表現&胚胎著床

子宮內膜異位症，輸卵管水腫，子宮肌瘤，子宮內膜息肉，多囊性卵巢
可能影響子宮內膜基因表現&相關蛋白產量，進一步影響胚胎著床

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039220/

In summary, infertility in endometriosis is not exclusively due to poor oocyte quality or embryo development but also the result of defective implantation. Decreased expression of implantation markers during the window of implantation, silencing of the HOXA10 gene, due to hypermethylation and progesterone resistance may lead to impaired implantation in endometriosis.

Table I

Proposed mechanisms of implantation failure in gynecological diseases.

Gynecological disease	Proposed mechanism of implantation failure
Endometriosis	Reduced αvβ3 integrin and LIF expressions in the window of implantation
	Lack of IL-11 and IL-11Rα expressions in secretory phase
	Absence of HOXA10 and HOXA11 peak in secretory phase
	Elevated EMX2 expression
	Progesterone resistance
	Alteration in PR-A to PR-B ratio
	Decreased HOXA10 expression due to hypermethylation of its promoter region
Hydrosalpinx	Mechanical interference to apposition by bathing of endometrial lining with hydrosalpinx fluid intermittently
	Reduced avβ3 integrin and LIF expressions
	Decreased HOXA10 expression
Leiomyoma	Distorting endometrial lining
	Obstructing the tubal ostia or cervical canal
	Decreased HOXA10 and BTEB1 expressions
Endometrial polyp	Mechanical interference with sperm transport and embryo implantation
	Low IGFBP-1 and osteopontin levels in secretory phase
	Low progesterone receptor levels in secretory phase
PCOS	Decreased αvβ3 integrin, HOXA-10 and IGFBP-1 during secretory phase
	Overexpression of androgen receptors
	Failure to downregulate estrogen receptor-α in the window of implantation
	Overexpression of the steroid receptor coactivators AIB1 and TIF2