The University of Southampton
University of Southampton Institutional Repository

The molecular basis of recurrent pregnancy loss: impaired natural embryo selection

Teklenburg, G., Salker, Madhuri, Macklon, Nick S. and Brosens, Jan J. (2010) The molecular basis of recurrent pregnancy loss: impaired natural embryo selection Molecular Human Reproduction, 16, (12), pp. 886-896. (doi:10.1093/molehr/gaq079). (PMID:20847090).

Record type: Article


Recurrent pregnancy loss (RPL) is a common and distressing disorder. Chromosomal errors in the embryo are the single most common cause, whereas uterine factors are invariably invoked to explain non-chromosomal miscarriages. These uterine factors are, however, poorly defined. The ability of a conceptus to implant in the endometrium is normally restricted to a few days in the menstrual cycle. A limited ‘window of implantation’ ensures coordinated embryonic and endometrial development, thereby minimizing the risk of late implantation of compromised embryos. In this paper, we review emerging evidence, indicating that RPL is associated with impaired differentiation of endometrial stromal cells into specialized decidual cells. From a functional perspective, this differentiation process, termed decidualization, is not only critical for placental development but also signals the end of the implantation window and bestows on the endometrium the ability to recognize, respond to and eliminate implanting compromised embryos. Thus, we propose that spontaneous decidualization of the human endometrium, which inevitably causes menstrual shedding in the absence of a viable conceptus, serves as functional ‘window for natural embryo selection’. Conversely, impaired decidualization predisposes to late implantation, negates embryo quality control and causes early placental failure, regardless of the embryonic karyotype. This pathological pathway also explains the common observation that many RPL patients seem exceptionally fertile, often conceiving within one or two cycles. Thus, as the clinical correlate of inappropriate uterine receptivity, ‘superfertility’ should be considered as a genuine reproductive disorder that requires targeted intervention.

Full text not available from this repository.

More information

Published date: December 2010
Keywords: fertility, miscarriage, endometrium, decidualization, embryo


Local EPrints ID: 185253
ISSN: 1360-9947
PURE UUID: b79c936e-808b-4223-812a-51fbb7f49b2e

Catalogue record

Date deposited: 10 May 2011 09:08
Last modified: 18 Jul 2017 11:49

Export record



Author: G. Teklenburg
Author: Madhuri Salker
Author: Nick S. Macklon
Author: Jan J. Brosens

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.