Update on the pathogenesis of endometriosis-related infertility based on contemporary evidence

作者：Qing Qi, Yaonan Li, Ziqin Chen, Zhihui Luo, Ting Zhou, Jing Zhou, Yanlin Zhang, Song Chen, Ling Wang · 发表于：Frontiers in Endocrinology · 年份：2025 · DOI：10.3389/fendo.2025.1558271 · 被引用次数：22 · 研究领域：Endometriosis Research and Treatment、Reproductive System and Pregnancy、Uterine Myomas and Treatments

Endometriosis, the most prevalent cause of infertility, is associated with anatomical distortion leading to adhesions and fibrosis, as well as endocrine abnormalities and immune disorders. This review discusses the mechanisms underlying endometriosis-related infertility. Firstly, alterations in the hypothalamic-pituitary-ovarian axis lead to the secretion of gonadotropins and steroid hormones, with adverse effects on ovulation and implantation, leading to fertility decline. Secondly, dysregulation of the hypothalamic-pituitary-adrenal axis induces elevated serum cortisol and prolactin levels in patients with endometriosis, accounting for its regulation of stress, depression, and anxiety. Abnormal interactions between endometrial cells and the immune system change the local microenvironment, resulting in epithelial-mesenchymal transition and inflammation. Activated epithelial cells, stromal cells, and immunocytes produce various chemokines, cytokines, or autoantibodies, creating an unfavorable environment for embryo implantation. These findings suggest that alterations in the immune spectrum play a crucial role in endometriosis-related infertility. Thirdly, oxidative stress has adverse effects on the ovarian reserve and subsequent embryonic development, predicting another promising strategy for endometriosis-related infertility. An unbalanced redox state, including impaired mitochondrial function, dysregulated lipid metabolism, and iron-induced oxidative stress, generates a pr...