Traditional Chinese medicine formulas: mechanisms and clinical evidence for improving endometrial receptivity

Endometrial receptivity is a decisive factor for successful embryo implantation and remains a major bottleneck limiting pregnancy outcomes in assisted reproductive technology (ART). Accumulating evidence suggests that traditional Chinese medicine (TCM) formulas may improve endometrial receptivity through multitarget and multipathway regulation. Experimental and clinical studies indicate that representative formulas enhance angiogenesis by activating vascular endothelial growth factor-related signalling pathways, modulate immune homeostasis by promoting a Th2-dominant microenvironment while preserving implantation-related inflammatory responses and improve endometrial morphology by increasing thickness, glandular development and vascular perfusion. Clinically, these effects are associated with improved implantation and pregnancy rates, particularly in patients with refractory conditions such as polycystic ovarian syndrome, thin endometrium, ageing-related infertility, controlled ovarian hyperstimulation-induced endometrial impairment and chronic endometritis. Nevertheless, current evidence is heterogeneous, with variations in study design, sample size and mechanistic depth across different formulas. This review systematically summarises the clinical evidence and molecular mechanisms underlying TCM formula-mediated improvement of endometrial receptivity, highlights existing limitations and discusses future research priorities to facilitate the integration of TCM-based interventions into modern reproductive medicine.