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doi:10.1056/NEJMoa1603827 98

It is a prevalent condition, impacting approximately 10% of women of reproductive age worldwideequating to around 190 million individualsand is highly associated with infertility, present in 3050% of women seeking infertility evaluation ( The pathophysiology involves complex interactions of endocrine, immunologic, and inflammatory processes, with retrograde menstruation as the most accepted theory for ectopic tissue implantation ( Clinical presentation is heterogeneous, encompassing menstruation-related pain (dysmenorrhea, dyspareunia), noncyclic pelvic pain, and infertility, with pain resulting from high densities of sensory nerve fibers in lesions and inflammatory processes ( Diagnosis remains challenging, often delayed by an average of 7 years from symptom onset, due to overlapping symptoms with other conditions and reliance on invasive laparoscopy with histological analysis as the gold standard ( 2 Pathophysiological mechanisms underlying infertility in endometriosis Endometriosis-associated infertility remains a complex and challenging clinical issue, with its underlying pathophysiological mechanisms being multi-faceted and interconnected