Decidualization Score test

Endometrial receptivity is essential for successful embryo implantation and normal pregnancy establishment. Impaired decidualization of the endometrium is associated with reproductive failure, including recurrent implantation failure and infertility.

The Decidualization Score Test is a molecular assay performed on endometrial biopsy samples to evaluate uterine receptivity based on expression of six key genes involved in decidualization and endometrial function:
FOXO1, GZMB, IL15, SCNN1A, SGK1, and SLC2A1.

These genes regulate processes essential for implantation, including epithelial integrity, immune modulation, metabolic adaptation, and stromal decidual transformation.

The Decidualization Score reflects the number of markers expressed within the normal reference range:

• Score >4: Normal decidualization (implantation-friendly endometrium)
• Score = 4: Borderline normal
• Score <4: Low decidualization (reduced endometrial receptivity)

Low scores may indicate impaired endometrial function and may guide personalized therapeutic interventions prior to IVF-ET procedures.

• Room temperature: stable up to 1 week
• Refrigerated (2–8°C): stable up to 1 month
• Ship at ambient temperature in stabilization solution

Transport medium:

• Place specimen into 3 mL RNA stabilization solution (provided by laboratory)

• Natural cycle: LH + 7 to LH + 9 days (LH surge = LH+0; identified via urinary LH kits)
• HRT cycle: Progesterone + 5 days (P+0 = first progesterone dose; biopsy at P+5)

Targeted transcriptomic analysis using Next-Generation Sequencing (NGS)-based RNA sequencing (targeted RNA-seq)

Normal Decidualization (>4): Gene expression profile consistent with normal endometrial receptivity. Implantation environment considered favorable.

Borderline (4): Intermediate decidualization profile. May indicate partial impairment of endometrial receptivity. Clinical correlation recommended.

Low Decidualization (<4): Reduced expression of key decidualization markers. Suggests impaired endometrial receptivity and may be associated with implantation failure or recurrent reproductive loss.

Results should be interpreted in conjunction with clinical history and fertility evaluation.

• Díaz-Gimeno P. et al. A genomic diagnostic tool for human endometrial receptivity based on transcriptomic signature. Fertil Steril.
• Ledee N. et al. Uterine immune profile in repeated implantation failure. Am J Reprod Immunol.
• Vasquez YM. et al. FOXO1 regulates uterine epithelial integrity and implantation. PLoS Genet.
• Salker MS. et al. SGK1 dysregulation and reproductive failure. Nat Med.
• Ruan YC. et al. ENaC activation and implantation signaling. Nat Med.
• von Wolff M. et al. GLUT expression in endometrium and implantation. J Clin Endocrinol Metab.
• Brighton PJ. et al. Clearance of senescent decidual cells in endometrium. 2017.

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