Controlled ovarian hyperstimulation (COH) is an essential part of assisted reproductive technology, which significantly improves the pregnancy rates of in vitro fertilization-embryo transfer (IVF-ET). Despite the clear benefits of COH in promoting follicular development, increasing oocyte count, and enabling the selection of high-quality embryos for transfer, COH may involve changes in the implantation window, endometrial receptivity, progesterone and estradiol levels, as well as uterine contractility, potentially impacting embryo implantation and IVF pregnancy rates in infertile patients. This article reviews the pathophysiological mechanisms of endometrial changes resulting from COH, with the aim of better addressing the bottleneck problems in the clinical treatment of infertility.