Endometriosis and Infertility: Mechanisms, Clinical Impact, and Diagnostic Advances

Yashika Handa
In: Undergraduate Research in Natural and Clinical Science and Technology Journal · 2026 · pp. 1–5 · doi:10.26685/urncst.1179 · W7215029650
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This review examines infertility as a central consequence of endometriosis, linking pathophysiology to clinical impact through dysregulated pelvic immune environments and advancing diagnostic tools like imaging and the Endometriosis Fertility Index.

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This review examines the pathophysiology linking endometriosis to infertility, highlighting how an altered pelvic immune environment drives disease progression and reproductive failure. The authors identify aberrant macrophage and natural killer cell function as key mechanisms that create an inflammatory milieu impairing gamete quality and implantation success. While anatomical distortion and ovarian reserve loss contribute to clinical burden, recent advances in imaging and the Endometriosis Fertility Index enable more individualized diagnostic approaches. This paper is centrally about endometriosis — specifically its role as a primary cause of infertility through immune-mediated and structural mechanisms.

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Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus. It affects an estimated 10% of women and girls of reproductive age worldwide, or approximately 190 million people, and diagnosis is delayed by six to ten years on average because symptom presentation is heterogeneous and no non-invasive test is definitive. This entry examines infertility, which affects roughly 30% of individuals with endometriosis, as a central consequence of the disease. It advances a single organizing argument: dysregulation of the pelvic and endometrial immune environment links the pathophysiology of endometriosis to its clinical impact on fertility and to emerging diagnostic and prognostic tools. Aberrant macrophage and natural killer (NK) cell function permits ectopic lesions to persist while generating an inflammatory milieu that impairs sperm, oocyte, and embryo quality and disrupts implantation. These mechanisms, together with anatomic distortion and endometrioma-related loss of ovarian reserve, explain the clinical burden of endometriosis-associated infertility. Advances in pelvic imaging, ovarian reserve testing, and the Endometriosis Fertility Index now allow clinicians to individualize fertility care, while biomarkers derived from the underlying immune alterations remain an active area of investigation.
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Endometriosis and Infertility: Mechanisms, Clinical Impact, and Diagnostic Advances ##plugins.themes.bootstrap3.article.main## Abstract Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus. It affects an estimated 10% of women and girls of reproductive age worldwide, or approximately 190 million people, and diagnosis is delayed by six to ten years on average because symptom presentation is heterogeneous and no non-invasive test is definitive. This entry examines infertility, which affects roughly 30% of individuals with endometriosis, as a central consequence of the disease. It advances a single organizing argument: dysregulation of the pelvic and endometrial immune environment links the pathophysiology of endometriosis to its clinical impact on fertility and to emerging diagnostic and prognostic tools. Aberrant macrophage and natural killer (NK) cell function permits ectopic lesions to persist while generating an inflammatory milieu that impairs sperm, oocyte, and embryo quality and disrupts implantation. These mechanisms, together with anatomic distortion and endometrioma-related loss of ovarian reserve, explain the clinical burden of endometriosis-associated infertility. Advances in pelvic imaging, ovarian reserve testing, and the Endometriosis Fertility Index now allow clinicians to individualize fertility care, while biomarkers derived from the underlying immune alterations remain an active area of investigation. ##plugins.themes.bootstrap3.article.details## This work is licensed under a Creative Commons Attribution 4.0 International License.

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