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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-) 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

These studies were conducted by a single research laboratory and, for many years, lacked independent replication outside that group

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