Endometriosis Uncovered: From Chronic Inflammation to Reproductive Dysfunction and Impaired ART Outcomes

Luana Ghilea Seleș, Ghilea Seleș L, Murvai VR, Viorela-Romina Murvai, Viorela Romina Murvai, Laura Maghiar, A B Bodog, Alin Bodog, Bodog A, Huniadi A, Anca Huniadi
Medicina (Kaunas, Lithuania) · 2026 · vol. 62(5) , pp. 885 · doi:10.3390/medicina62050885 · PMID:42195138 · W7160270264
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This review examines how endometriosis-associated chronic inflammation and immune dysregulation negatively impact reproductive function and assisted reproductive technology outcomes.

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Abstract

Background and Objectives: Endometriosis is a chronic, estrogen-dependent disorder characterized by the presence of functional endometrial tissue, comprising both glandular and stromal components, located outside the uterine cavity, affecting approximately 6-10% of women of reproductive age and up to 30-50% of those with infertility. Increasing evidence indicates that endometriosis is not solely a localized gynecological condition but rather a systemic inflammatory and immune-mediated disease. Chronic inflammation and immune dysregulation contribute to disease progression and may impair reproductive function. This review aims to analyze the current evidence regarding the inflammatory and immunological mechanisms underlying endometriosis and to evaluate their impact on reproductive dysfunction and assisted reproductive technology (ART) outcomes. Materials and Methods: A comprehensive narrative review was conducted using major scientific databases, including PubMed, Scopus, and Web of Science. Relevant articles published in the last decade were selected using keywords such as "endometriosis", "inflammation", "immune response", "cytokines", and "ART outcomes". Both clinical and experimental studies were included to assess the relationship between inflammatory markers, immune alterations, and reproductive performance. Results: Endometriosis is associated with elevated levels of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α), as well as increased oxidative stress and altered peritoneal microenvironment. Immune dysfunction is characterized by activated macrophages, decreased natural killer (NK) cell cytotoxicity, and an imbalance in T-cell populations. These alterations negatively affect oocyte quality, fertilization, embryo development, and endometrial receptivity. Emerging biomarkers such as IL-6, TNF-α, and CA-125 show potential in predicting disease severity and ART outcomes, although their clinical utility remains under investigation. Conclusions: Endometriosis should be regarded as a systemic immuno-inflammatory disorder with significant implications for reproductive health. The interaction between chronic inflammation and immune dysregulation plays a central role in infertility and suboptimal ART outcomes. Further research is required to validate reliable biomarkers and develop targeted therapeutic strategies to improve reproductive success in affected patients.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (84)

Cited by (3)

SciLite annotations

chemicals 13
estrogen prostaglandin prostaglandin e2 estrogen estrogen oxygen lipid oxygen lipid lipid prostaglandin elagolix estrogen

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