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Dysregulated T helper cytokines in serum and peritoneal fluid of women with endometriosis-related infertility Cover

Dysregulated T helper cytokines in serum and peritoneal fluid of women with endometriosis-related infertility

Asian Biomedicine
Volume 20 (2026): Issue 4 (August 2026)
By: ,  ,  ,  ,  ,   and    
Open Access
|Aug 2026
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Figures & tables

Figures & Tables

Table 1.

Patient's characteristics

VariablesControl (n = 43)Endometriosis (n = 44)Pc
Age (years)a31 (28–36)30 (28–33)0.580
Body mass index (BMI)a22.80 (20.40–25.30)23.20 (20.40–26.50)0.544
Dymenorrheab,d0.134
  Yes16 (37.21%)24 (54.55%)
  No27 (62.79%)20 (45.45%)
Dyspareuniab,d0.229
  Yes4 (9.30%)9 (20.46%)
  No39 (90.69%)35 (79.54%)
rASRM scoreaN/A
  Endometriosis scoreN/A22 (8.00–47.50)
  Adhesion score9.50 (2.25–17.25)
Total EFI scoreaN/A5.50 (4–7)N/A
Menstrual cycleb0.391
  Follicular17 (39.53%)22 (50.00%)
  Luteal26 (60.46%)22 (50.00%)

Data are shown as

a median (25%–75% percentile) and

b frequency (percentage).

c Statistical analysis was performed using a two-tailed Mann-Whitney U test.

d Symptoms in the previous month based on anamnesis.

rASRM, revised American Society for Reproductive Medicine; EFI, Endometriosis Fertility Index; N/A: Not applicable.

Figure 1.

Serum and peritoneal Th cytokine levels in endometriosis and gynecologic control patients. Scatter plots of (A) serum and (D) peritoneal IL-4, IL-5, IL-10, IL-17A, IL-17F, and IFN-γ levels in endometriosis and control groups. (B) Serum and (E) peritoneal IL-4 and IL-5 levels stratified by disease stage (stage I/II and III/IV) compared to control cases. (C) Serum and (F) peritoneal IL-4 and IL-5 levels in different control subgroups-fallopian, ovary, and myoma-compared to endometriosis. A dot represents each subject. P-values are indicated. Endo, Endometriosis group. Ctrl, Control group. Th, T helper.

Figure 2.

Spearman correlation analysis between serum cytokine levels and rASRM scores. Correlations between (A) IL-4, (B) IL-5, (C) IL-10, (D) IL-17A, (E) IL-17F, and (F) IFN-γ levels with rASRM endometriosis and adhesion scores. Rho (r) and P-values are indicated. rASRM, revised American Society for Reproductive Medicine.

Figure 3.

Spearman correlation analysis between serum cytokine levels and EFI scores. Correlations between (A) IL-4, (B) IL-5, (C) IL-10, (D) IL-17A, (E) IL-17F, and (F) IFN-γ levels with the total EFI scores. Rho (r) and P-values are indicated. EFI, Endometriosis Fertility Index.

Figure 4.

ROC curve analysis for cytokines in serum. (A) Serum IL-4 and IL-5 in differentiating endometriosis from control cases. (B) Serum IL-10 and IL-17F in differentiating EFI scores above 5 versus 5 or below. The AUC and P-values are indicated. AUC, area under the curve; EFI, Endometriosis Fertility Index; ROC, receiver operating characteristic.

Table S1.

Th cytokine levels in endometriosis stages

Stage I (n = 6)Stage II (n = 9)Stage III (n = 14)Stage IV (n = 15)
IL-4 (Serum)26.38 (15.22–40.98)41.68 (36.81–44.54)33.63 (30.69–42.74)42.07 (34.90–48.41)0.059
IL-4 (Peritoneal fluid)37.81 (15.94–59.50)38.51 (34.35–46.61)45.72 (37.77–51.29)36.36 (33.89–46.86)0.449
IL-5 (Serum)10.80 (6.13–15.58)13.91 (12.19–16.82)9.13 (8.06–11.79)16.12 (10.61–20.90)0.026*
IL-5 (Peritoneal fluid)8.18 (4.13–42.73)16.37 (13.42–25.50)17.96 (15.19–29.79)16.29 (13.11–20.36)0.463
IL-10 (Serum)1.43 (1.07–5.67)1.98 (1.11–2.98)3.85 (2.92–6.75)3.18 (2.65–7.51)0.019*
IL-10 (Peritoneal fluid)3.33 (1.19–12.35)3.79 (3.09–10.62)3.53 (3.01–8.52)28.32 (4.77–40.13)0.064
IL-17A (Serum)6.38 (3.79–11.60)9.23 (6.03–32.09)18.09 (14.85–20.68)11.64 (8.58–22.54)0.057
IL-17A (Peritoneal fluid)2.99 (1.20–7.03)6.20 (4.88–14.99)4.48 (3.36–12.79)6.03 (4.52–14.42)0.134
IL-17F (Serum)2.98 (2.10–4.05)2.27 (2.19–4.38)4.91 (3.12–7.16)6.18 (4.35–6.91)0.017*
IL-17F (Peritoneal fluid)2.92 (2.62–4.79)2.44 (2.17–4.53)2.29 (2.17–4.59)2.25 (2.15–4.43)0.311
IFN-γ (Serum)10.16 (8.42–32.51)15.31 (13.78–25.65)58.98 (20.84–73.00)12.84 (10.27–21.21)0.007*
IFN-γ (Peritoneal fluid)11.96 (8.10–17.27)20.34 (19.30–24.58)16.03 (13.89–25.91)21.71 (17.60–47.67)0.011*

Data is shown as

a median (25%–75% percentile).

b Statistical analysis performed with the Kruskal-Wallis test to rank all data across all groups.

* Significant P-value. IL, Interleukin; IFN, Interferon.

Table S2.

Th cytokine levels and EFI score

Cytokine (Source)EFI Score ≤5aEFI Score >5aPb
IL-4 (Serum)33.53 (25.24–43.08)37.33 (25.29–46.51)0.314
IL-4 (Peritoneal fluid)39.57 (29.12–47.92)37.19 (24.09–50.27)0.743
IL-5 (Serum)10.40 (6.87–13.99)10.18 (6.85–16.13)0.969
IL-5 (Peritoneal fluid)13.91 (6.32–18.44)15.06 (8.85–18.81)0.816
IL-10 (Serum)2.65 (1.48–3.97)2.82 (1.50–4.23)0.813
IL-10 (Peritoneal fluid)6.84 (3.05–15.23)3.89 (2.93–6.56)0.111
IL-17A (Serum)11.03 (7.15–18.55)16.32 (7.95–21.49)0.120
IL-17A (Peritoneal fluid)4.13 (2.60–7.18)5.46 (4.04–10.79)0.353
IL-17F (Serum)5.18 (3.59–6.18)2.68 (2.86–3.49)0.030*
IL-17F (Peritoneal fluid)5.48 (3.12–6.87)2.19 (2.03–2.40)0.015*
IFN-γ (Serum)15.25 (10.35–24.66)18.10 (8.96–65.72)0.362
IFN-γ (Peritoneal fluid)18.74 (13.23–25.54)19.66 (14.12–29.64)0.565

Data is shown as

a median (25%–75% percentile).

b Statistical analysis was performed using a two-tailed Mann-Whitney U test.

* Significant p-value.

EFI, Endometriosis Fertility Index; IL, Interleukin; IFN, Interferon.

Table S3.

Th cytokines and menstrual cycle

VariableaPopulationFollicular phaseLuteal phasePb
Serum IL-4All subject Endometriosis Control

  • 39.59 (29.32 – 45.19)

  • 38.38 (30.57 – 45.55)

  • 39.30 (23.93 – 47.18)

  • 33.63 (20.68 – 41.90)

  • 38.44 (33.37 – 45.89)

  • 25.00 (11.45 – 37.04)

  • 0.160

  • 0.638

  • 0.085

Peritoneal IL-4All subject Endometriosis Control

  • 40.79 (28.24 – 50.98)

  • 37.00 (26.94 – 51.87)

  • 44.45 (28.37 – 55.09)

  • 38.42 (19.53 – 47.86)

  • 43.04 (36.31 – 49.00)

  • 28.58 (14.71 – 46.50)

  • 0.380

  • 0.270

  • 0.080

Serum IL-5All subject Endometriosis Control

  • 10.61 (6.64 – 14.41)

  • 11.26 (8.79 – 17.50)

  • 8.85 (6.05 – 13.65)

  • 10.33 (6.99 – 14.54)

  • 13.42 (9.58 – 17.56)

  • 8.77 (4.84 – 10.80)

  • 0.609

  • 0.629

  • 0.543

Peritoneal IL-5All subject Endometriosis Control

  • 15.41 (9.52 – 19.41)

  • 16.02 (9.94 – 23.09)

  • 13.60 (5.63 – 17.95)

  • 13.80 (6.38 – 18.11)

  • 16.84 (14.40 – 29.79)

  • 8.46 (4.73 – 14.12)

  • 0.553

  • 0.392

  • 0.210

Serum IL-10All subject Endometriosis Control

  • 3.13 (1.28 – 5.21)

  • 3.51 (2.31 – 5.36)

  • 2.21 (1.28 – 5.40)

  • 2.46 (1.57 – 3.72)

  • 2.74 (1.14 – 4.46)

  • 2.33 (1.60 – 3.50)

  • 0.140

  • 0.275

  • 0.690

Peritoneal IL-10All subject Endometriosis Control

  • 6.25 (2.89 – 12.77)

  • 6.46 (2.88 – 12.87)

  • 5.96 (3.08 – 14.89)

  • 5.13 (3.08 – 12.74)

  • 4.29 (3.14 – 29.60)

  • 5.40 (2.99 – 9.66)

  • 0.877

  • 0.812

  • 0.649

Serum IL-17AAll subject Endometriosis Control

  • 16.32 (9.23 – 21.46)

  • 15.34 (9.17 – 21.75)

  • 16.32 (9.15 – 20.18)

  • 10.43 (6.14 – 17.61)

  • 11.34 (7.08 – 19.39)

  • 9.71 (5.70 – 16.51)

  • 0.036*

  • 0.185

  • 0.100

Peritoneal IL-17AAll subject Endometriosis Control

  • 5.83 (3.03 – 14.42)

  • 5.60 (3.23 – 15.80)

  • 5.83 (2.41 – 13.02)

  • 4.72 (2.64 – 9.13)

  • 5.43 (3.36 – 8.13)

  • 4.01 (1.66 – 9.82)

  • 0.451

  • 0.714

  • 0.663

Serum IL-17FAll subject Endometriosis Control

  • 2.42 (1.20 – 5.87)

  • 3.15 (1.17 – 6.95)

  • 2.39 (1.80 – 5.37)

  • 1.72 (1.12 – 5.30)

  • 1.88 (1.17 – 5.61)

  • 1.57 (1.05 – 3.42)

  • 0.279

  • 0.581

  • 0.434

Peritoneal IL-17FAll subject Endometriosis Control

  • 1.27 (1.12 – 1.52)

  • 1.27 (1.17 – 1.44)

  • 1.28 (1.03 – 1.82)

  • 1.23 (1.01 – 1.57)

  • 1.30 (1.16 – 1.56)

  • 1.04 (1.01 – 1.11)

  • 0.469

  • 0.379

  • 0.221

Serum IFN-γAll subject Endometriosis Control

  • 18.70 (10.35 – 44.34)

  • 25.22 (10.75 – 59.83)

  • 17.29 (10.35 – 24.80)

  • 14.77 (9.78 – 21.71)

  • 15.96 (10.75 – 35.86)

  • 14.33 (7.88 – 19.21)

  • 0.164

  • 0.542

  • 0.251

Peritoneal IFN-γAll subject Endometriosis Control

  • 17.60 (14.35 – 26.03)

  • 18.40 (14.72 – 31.08)

  • 17.13 (10.58 – 26.11)

  • 19.03 (12.43 – 25.22)

  • 20.16 (15.23 – 24.41)

  • 17.05 (9.34 – 26.20)

  • 0.633

  • 0.940

  • 0.740

Data is shown as

a median (25%–75% percentile).

b Statistical analysis was performed using a two-tailed Mann-Whitney U test.

* Significant P-value. IL, Interleukin; IFN, Interferon.

DOI: https://doi.org/10.2478/abm-2026-0028 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 248 - 259
Published on: Aug 31, 2026
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Keywords:
biomarker,
endometriosis,
gynecologic inflammation,
infertility,
interleukin,
reproductive immunology,
T helper cytokine,
Th1/Th2 balance,
Th2 immune response
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2026 Fadhil Ahsan, Nanda Yuli Rahmawati, M. Y. Ardianta Widyanugraha, Arif Tunjungseto, Sri Ratna Dwiningsih, Ashon Sa'adi, Budi Santoso, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 20 (2026): Issue 4 (August 2026)
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