[Immunological aspects of endometriosis]

The effect of adherence process on Fallopian tubes and ovaries in late stages endometriosis is clear, but it is more important to understand pathophysiologic mechanism of infertility in minimal, mild endometriosis. Although the etiology of endometriosis is unknown, components of the immune system may be involved and play a central role in the pathogenesis of the disease by immunologically altering the peritoneal microenvironment. Increased number and activity of leucocyte subpopulations in the peritoneal fluid result in cytotoxic effects that exert adverse influence on spermatozoa, oocyte, germ cell interaction, and early embryo development, while cytokine and growth factor secretion stimulates or promotes cellular proliferation of endometriotic tissue in an "immunological tolerance" environment. The immunological aspects of endometriosis, including autocrine or paracrine pathways of intercellular communication, are reviewed.