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The deletion of FSHR , LHR , or both, impedes granulosa cell survival and follicle development, ultimately altering oocyte quality through failure of cell maturation ( LHR in patients with endometriosis and infertility, suggesting impaired LH function in patients with endometriosis/infertility ( 2.1.2 Estrogen and estrogen receptors (ERs) Endometriosis is an estrogen-dependent disease in which estrogen accumulation affects the progression of endometriotic lesions by binding to and activating ERs, including ERα and ERβ ( in situ endometrium, accompanied by high estrogen levels, which are responsible for a high rate of implantation failure in patients with infertile ovarian endometriosis ( in vitro , probably creating a permissive environment for oocyte movement, fertilization, and implantation ( The interactions between high estrogen levels and the gut microbiota (GM) detrimentally affect embryo implantation and fertility by altering the cervical vaginal microenvironment, such as increased pH, bacterial overgrowth, and increased levels of inflammatory factors