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Background The mechanisms of endometriosis with infertility have not been fully studied.The present study aimed to assess the follicular fluid(FF)levels of prostaglandin E2(PGE2),which plays a critical role within the ovary,and to investigate the effect of PGE2 on steroidogenesis in granulosa-lutein cells(GLCs)from women with and without endometriosis.Methods Thirty-three women with laparoscopically documented endometriosis and 40 controls undergoing in vitro fertilization(IVF)were studied.We assayed the concentrations of PGE2 in FF,the production of E2 and progesterone in FF and in culture medium,and the expression of steroidogenic acute regulatory protein(StAR)and CYP19A1 in GLCs with the intervention of PGE2.Results PGE2 and progesterone concentrations were increased and displayed positive correlation in endometriotic FF.PGE2 induced the expression of StAR and the production of progesterone in GLCs from women with endometriosis,and the expression of StAR and the production of progesterone were increased in GLCs from women with endometriosis.However,there were no significant effects of PGE2 on promoting the production of E2 or the expression of CYP19A1 in GLCs.Moreover,the production of E2 and the expression of CYP19A1 in GLCs from women with endometriosis were significantly decreased compared to the controls.Conclusions PGE2 concentrations are increased in endometriotic FF,along with concomitant increases in progesterone and StAR.In contrast,the E2 and CYP19A1 are decreased in GLCs,which may delay the development of the follicles and cause an imbalance in the follicular steroid hormone levels.These changes may have close relationship with endometriosis-associated infertility.