Introduction Endometriosis, the presence of endometrial-like tissue (glands and stroma) outside the uterine cavity, is a chronic estrogen-dependent inflammatory disease affecting approximately 10-15% of reproductive-age women and 3550% of women with pelvic pain and/or infertility worldwide ( A complex network of molecular, cellular, and hormonal factors could help unravel the underlying pathogenic mechanism for declined reproductive outcomes of endometriosis patients ( The assisted reproductive technique (ART) is the main treatment option for endometriosis-induced infertility ( Astaxanthin (dihydroxy-4,4-dione- ,-carotene: AST), called the king of antioxidants, is a red-orange, lipid-soluble xanthophyll photo-pigmented ketocarotenoid isolated from the alga Haematococcus pluvialis with an antioxidant activity 10 times stronger than that of other natural carotenoids ( AST targets several molecules and pathways, including phosphoinositide 3-kinases (PI3K)/Akt and Janus kinase-2/signal transducer and activator of transcription-3 (JAK2/STAT3) signaling pathways, NF-B family, mitogen-activated protein kinases (MAPKs), nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), and peroxisome proliferator-activated receptor gamma (PPAR) to efficiently modulate the dynamic oxidant: antioxidant equilibrium ( via the Nrf2/HO-1 antioxidant signaling pathway, and increases the expression of its antioxidant target genes, including the phase II biotransformation enzyme ( Furthermore, AST suppresses the expression of scavenger receptors, controlled by NFB, the main mediator of the inflammatory response through inhibiting IB- degeneration and the NF-B nuclear translocation ( via inhibition of the MAPK signaling pathway by reducing the induction and expression of extracellular-signal-regulated kinase (ERK1/2), c-Jun N-terminal kinases (JNK), and p38 MAP Kinase ( Fertility-enhancing properties of AST have been established in various in vitro and in vivo studies
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& Afifi, A
HIF-1, Hypoxia-Inducible Factor 1
