Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy

Kamila Kolanska, Jaume Alijotas-Reig, Jaume Alijotas‐Reig, Jonathan Cohen, M. Cheloufi, Meryem Cheloufi, Lise Selleret, Emmanuelle d'Argent, Emmanuelle d’Argent, Gilles Kayem, Enrique E Valverde, Enrique Esteve Valverde, Olivier Fain, O. Fain, Marie Bornes, Emile Darai, Émile Daraï, Arsene Mekinian, A. Mékinian
American journal of reproductive immunology (New York, N.Y. : 1989) · 2020 · vol. 85(3) , pp. e13384 · doi:10.1111/aji.13384 · PMID:33278837 · W3111223546
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

Endometriosis-associated infertility involves immune deregulation, evidenced by elevated cytokines and autoantibodies, prompting investigation into immunomodulatory therapies like steroids and TNF-α antagonists.

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Abstract

BACKGROUND: Endometriosis is a multifactorial pathology dependent on intrinsic and extrinsic factors, but the immune deregulation seems to play a pivotal role. In endometriosis-associated infertility, this could raise the benefit of immunomodulatory strategies to improve the results of ART. In this review, we will describe (1) sera and peritoneal fluid cytokines and immune markers; (2) autoantibodies; and (3) immunomodulatory treatments in endometriosis with infertility. METHODS: The literature research was conducted in MEDLINE, Embase, and Cochrane Library with the following keywords: "endometriosis", "unexplained miscarriage", "implantation failure", "recurrent implantation failure » and « IVF-ICSI », « biomarkers of autoimmunity", "TNF-α", "TNF-α antagonists", "infliximab", "adalimumab", "etanercept", "immunomodulatory treatment", "steroids", "intralipids", "intravenous immunoglobulins", "G-CSF", "pentoxyfylline". RESULTS: Several studies analyzed the levels of pro-inflammatory cytokines in sera and peritoneal fluid of endometriosis-associated infertility, in particular TNF-α. Various autoantibodies have been found in peritoneal fluid and sera of infertile endometriosis women even in the absence of clinically defined autoimmune disease, as antinuclear, anti-SSA, and antiphospholipid autoantibodies. In few uncontrolled studies, steroids and TNF-α antagonists could increase the pregnancy rates in endometriosis-associated infertility, but well-designed trials are lacking. CONCLUSION: Endometriosis is characterized by increased levels of cytokines and autoantibodies. This suggests the role of inflammation and immune cell deregulation in infertility associated with endometriosis. The strategies of immunomodulation to regulate these immune deregulations are poorly studied, and well-designed studies are necessary.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Endometriosis Immunotherapy Infertility, Female Pregnancy Autoantibodies Autoantibodies Biomarkers Biomarkers Cytokines Cytokines Endometriosis Female Humans Immunity Immunomodulation Immunotherapy Infertility, Female Pregnancy

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 (87)

Cited by (50)

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