The widespread adoption of unproven empirical treatments that aim to improve endometrial receptivity after in vitro fertilization (IVF) treatment says much about the challenges that clinicians face as they seek to help patients struggling to conceive. Developments in ovarian stimulation protocols and laboratory techniques have improved IVF outcomes, and the great majority of women will now, after undergoing treatment, have embryos available for transfer into the uterus. Since the development of IVF, clinical research in the field of infertility has focused primarily on improving embryo quality, as the embryo has been considered to be the prime determinant of successful implantation. Although embryo quality is an important factor in successful implantation, the quality and function of the endometrium are increasingly being recognized as the key factors determining further improvement in outcomes. However, for clinicians, there has been a frustrating lack of validated clinical investigational tools for interrogating endometrial receptivity in a clinical setting. As a result, most current therapeutic interventions aimed at modulating receptivity are largely empirical, based on a degree of plausible biological rationale, but with little clinical evidence to support their use. The pressures to “do something” to “improve implantation,” which include assertive patient demand and the competitive commercial context in which IVF is increasingly practiced, continue to rise, and empirical treatments have come in to fill the gap between scientific rationale and clinical need.