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Emerging evidence suggests interventions like PPD may improve the endometrial environment by upregulating progesterone receptors, downregulating estrogen receptors, and normalizing immune cell function – including reducing pro-inflammatory cytokines (IL-12, IFN-γ) in macrophages and enhancing decidual NK cell-mediated immune tolerance and angiogenesis ( 3.3 Tubal and anatomical factors Anatomical distortions caused by adhesions and fibrosis represent key contributors to infertility in endometriosis, leading to mechanical obstruction and impaired pelvic anatomy relevant to reproductive function

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