"It is likely that an alternate mechanism exists in obesity that may be responsible for ‘biological super-fertility’ in obese women. Teklenburg et al.40 elegantly showed that the endometrial stromal cells transform into biological sensors of embryo quality upon decidualisation. There is a good body of evidence, from in vitro studies, to suggest that the inability of the peri‐implantation endometrium to mount an adequate decidual response impairs embryo recognition and selection upon implantation,34, 40, 41, 43, which leads to shorter TTP intervals and predisposes to RMC. This abnormal phenotype results in an extended window of implantation, which reduces the endometrial ability to be ‘selective’ in response to embryo quality.8 This concept is consistent with the previously reported association of late implantation of embryos with an increased risk of early miscarriage.44 The findings from our study may suggest that an obesogenic environment might have a negative influence on the peri‐implantation endometrium, which would predispose women to RMC."
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Miscarriage
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