The incidence of infertility in patients with endometriosis (EMS) is as high as 30%-50%, of which the common causes including the fallopian tube obstruction, pelvis adhesion, endocrine disorders, abnormal embryo quality, inflammation, immune disorders and impaired endometrial receptivity. Recent studies have shown that impaired endometrial receptivity is closely associated with progesterone resistance. Among patients with EMS, progesterone resistance may be the result of multiple factors including dysregulated expression of progesterone receptor (PR) and the ratio of PRA/PRB, aberrant expression of several molecules in the downstream of PR signaling pathways, epigenetic alterations, endometrial chronic inflammation and so on. And progesterone resistance can lead to decreased progesterone-induced gene expression, receptivity-related proteins, endometrial morphological changes and insufficient decidualization, which in turn causes impaired endometrial receptivity and embryo implantation failure. We reviewed the detailed mechanism of the occurrence and development of progesterone resistance in EMS patients, aiming to provide a theoretical basis for exploring the therapies for improving the endometrial receptivity of EMS patients.

The incidence of infertility in patients with endometriosis (EMS) is as high as 30%-50%, of which the common causes including the fallopian tube obstruction, pelvis adhesion, endocrine disorders, abnormal embryo quality, inflammation, immune disorders and impaired endometrial receptivity. Recent studies have shown that impaired endometrial receptivity is closely associated with progesterone resistance. Among patients with EMS, progesterone resistance may be the result of multiple factors including dysregulated expression of progesterone receptor (PR) and the ratio of PRA/PRB, aberrant expression of several molecules in the downstream of PR signaling pathways, epigenetic alterations, endometrial chronic inflammation and so on. And progesterone resistance can lead to decreased progesterone-induced gene expression, receptivity-related proteins, endometrial morphological changes and insufficient decidualization, which in turn causes impaired endometrial receptivity and embryo implantation failure. We reviewed the detailed mechanism of the occurrence and development of progesterone resistance in EMS patients, aiming to provide a theoretical basis for exploring the therapies for improving the endometrial receptivity of EMS patients.