Relationship between the change of ATP level controlled by ectonucleotidases and endometriosis-associated infertility and pain

The dysfunction of the immune system is one of the pathogeneses of endometriosis. Immune cells can not only affect the microenvironment of the endometrium by secreting cytokines and defensins but also promote angiogenesis, growth and invasion of endometrial stromal cells.ATP is a key mediator in the immune mechanism of endometriosis and plays a crucial role in endometriosis. While ATP acts as a purinergic signalling molecule, it has a close relationship with the pain of endometriosis via activating ATP receptors, including P2X3, P2X4, P2X7 and P2Y receptors, after being activated by the immune system. Besides, ATP levels reflect the impairment of mitochondrial function in granulosa cells, which could lead to infertility. The modulation of ATP expression levels is controlled by ectonucleotidases. The content of ectonucleotidases is altered in endometriosis which may be emerging non-invasive biomarkers.In the present review, we briefly introduce the relationship between the change of ATP level controlled by ectonucleotidases and endometriosis-associated infertility and pain, and illustrate our prospects for future research.