Potential Changes in the Eutopic Endometrium in Endometriosis: A Narrative Review
Fanourios Makrygiannakis1, Thomas Vrekoussis1, Aikaterini Berdiaki1
1Obstetrics and Gynecology, University of Crete, Heraklion, GRC.
Cureus
|October 24, 2025
Summary
Endometriosis causes infertility by altering the uterine lining (endometrium). Research highlights inflammation, immune changes, and progesterone resistance in the endometrium, potentially explaining implantation failure and guiding new fertility treatments.
Area of Science:
- Reproductive Medicine
- Immunology
- Cell Biology
Background:
- Endometriosis involves ectopic endometrial tissue, leading to inflammation and infertility.
- Infertility in endometriosis patients often necessitates assisted reproduction techniques (ARTs).
- Endometriosis is increasingly recognized to impact both ovarian and endometrial function.
Purpose of the Study:
- To review alterations in the eutopic endometrium of women with endometriosis.
- Focus on inflammatory pathways, angiogenesis, and immune changes affecting implantation.
- To explore mechanisms contributing to endometrial dysfunction in endometriosis.
Main Methods:
- Literature review focusing on eutopic endometrial changes in endometriosis.
- Analysis of studies investigating inflammatory, immune, and angiogenic factors.
- Examination of research on epigenetic regulation and cellular metabolism.
Main Results:
- Pro-inflammatory macrophage and T helper 17 (Th17) profiles are associated with reduced endometrial receptivity.
- Hypoxic stress in endometriosis affects angiogenesis, epigenetic regulation, and endometrial cell metabolism.
- Progesterone resistance is implicated in impaired endometrial cell homeostasis.
Conclusions:
- Eutopic endometrial alterations, including inflammation and immune dysregulation, contribute to infertility in endometriosis.
- Hypoxia and epigenetic changes disrupt endometrial function and receptivity.
- Understanding these mechanisms offers targets for novel therapeutic strategies in endometriosis-associated infertility.
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