Introduction
As an important breakthrough in modern reproductive medicine, assisted reproductive technology (ART) has provided key technical support for fertility preservation.1 However, despite the remarkable progress in ART, the overall clinical pregnancy rate remains approximately 40%, with endometrial receptivity and embryo quality considered the most critical contributing factors.2–4 During embryo implantation, the establishment of a receptive endometrium is essential for the success of pregnancy.5
Endometrial receptivity refers to the ability of the endometrium to accept and support embryo attachment, invasion and subsequent placental development at a specific time.3 This process typically occurs 7–9 days after ovulation, a period known as the implantation window.6 During this time, the uterine lining must be synchronised with embryonic development to ensure successful implantation. However, impaired endometrial receptivity is a major cause of implantation failure in both natural conception and ART.7 Key conditions linked to reduced receptivity include polycystic ovarian syndrome (PCOS), characterised by hyperandrogenism and chronic inflammation; thin endometrium (TE), marked by inadequate proliferation and poor perfusion; reproductive ageing, driven by oxidative stress and cellular senescence; controlled ovarian hyperstimulation (COH), causing hormonal fluctuations and structural asynchrony; and chronic endometritis (CE), due to immune dysregulation. The overlapping pathophysiological mechanisms—disrupted angiogenesis, immune imbalance and hormonal abnormalities—compromise the endometrial microenvironment, leading to implantation failure. This review focuses on these conditions and the therapeutic potential of traditional Chinese medicine (TCM) formulas. Although several therapeutic strategies are currently available, such as hormone modulation, improved uterine perfusion and surgical interventions, their clinical efficacy remains limited.8
Herbal compounding has been widely used in the treatment of infertility and reproductive disorders since ancient times.9–11 Unlike traditional treatments that focus on oestrogen and progesterone supplementation, TCM formulas improve endometrial receptivity through a holistic and multitargeted approach. TCM formulas typically consist of a combination of herbs with synergistic actions that can regulate and repair endometrial function through multiple mechanisms.12 In recent years, specific TCM formulas have demonstrated promising effects in promoting endometrial proliferation, regulating immune tolerance, enhancing angiogenesis and reducing oxidative stress. However, despite their apparent potential, the active components and precise mechanisms of action of Chinese herbal compounds remain incompletely understood and require further scientific investigation.
Therefore, the aim of this review is to comprehensively explore the role of Chinese herbal compounds in improving endometrial receptivity and to summarise current clinical evidence, intervention characteristics and key mechanisms. A summary table (table 1) is provided to facilitate comparison of different formulas in terms of indications, major components, clinical outcomes and mechanistic pathways. These mechanistic differences arise from variations in herbal composition and therapeutic focus, resulting in preferential modulation of specific signalling pathways or cellular processes by different formulas.
In addition, we discuss strategies for optimising the integration of TCM formulas into modern reproductive medicine, aiming to advance clinical applications and provide novel therapeutic perspectives for improving implantation outcomes.13