{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:08:56Z","timestamp":1789016936459,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometriosis is a chronic inflammatory disease linked to infertility. Coagulation-related processes may contribute to lesion persistence and pelvic remodeling, but the relevance of coagulation parameters in women with infertility undergoing surgical evaluation remains unclear. This study examined the association of plasma fibrinogen (FIB) with the presence and stage of endometriosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study included 389 women with infertility undergoing combined hysteroscopy and laparoscopy. Endometriosis was surgically confirmed and staged using the revised American Society for Reproductive Medicine classification. Plasma FIB was analyzed continuously and by quartiles. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for overall and stage-specific endometriosis after adjustment for age, body mass index, education level, dysmenorrhea, and parity. Spline analyses explored potential nonlinearity. Activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and international normalized ratio (INR) were exploratory comparators. Sensitivity analyses considered reproductive, inflammatory, and coagulation-related variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 389 women, 259 had endometriosis, including 186 with stage I\u2013II and 73 with stage III\u2013IV disease. Continuous FIB was not significantly associated with overall endometriosis (OR, 1.20; 95% CI, 0.76\u20131.91; P\u00a0=\u00a00.433). Compared with the first quartile, the third FIB quartile was associated with higher odds of overall endometriosis (OR, 2.37; 95% CI, 1.20\u20134.66; P\u00a0=\u00a00.012), with the largest estimate for stage III\u2013IV disease (OR, 4.03; 95% CI, 1.56\u201310.43; P\u00a0=\u00a00.004). Q4 did not show a further increase, and trend tests were not significant. The adjusted spline increased across the lower-to-middle FIB range and then plateaued. The overall Q3 estimate remained elevated across sensitivity analyses, including the exploratory expanded model (OR, 2.27; 95% CI, 1.09\u20134.75). APTT, PT, TT, and INR showed no consistent associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Plasma FIB did not show a simple linear association with endometriosis. A higher estimate was observed in the intermediate FIB range and persisted across several adjusted analyses, particularly in stage III\u2013IV disease. This quartile-specific pattern remains exploratory and does not define a clinical cutoff. Independent cohorts are needed to determine whether this pattern is reproducible and clinically informative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1929933","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:18Z","timestamp":1789014738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Plasma fibrinogen levels in women with infertility undergoing surgical evaluation for endometriosis: a retrospective cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Huanying","family":"Xu","sequence":"first","affiliation":[{"name":"Foshan Clinical Medical School of Guangzhou University of Chinese Medicine","place":["Foshan, Guangdong, China"]},{"name":"Department of Traditional Chinese Medicine (TCM) Gynecology, Foshan Fosun Chancheng Hospital","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaocheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine, School of Basic Medical Sciences","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine, School of Basic Medical Sciences","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Mi","sequence":"additional","affiliation":[{"name":"Foshan Clinical Medical School of Guangzhou University of Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine (TCM) Gynecology, Foshan Fosun Chancheng Hospital","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzhen","family":"Wu","sequence":"additional","affiliation":[{"name":"Foshan Clinical Medical School of Guangzhou University of Chinese Medicine","place":["Foshan, Guangdong, China"]},{"name":"Department of Traditional Chinese Medicine (TCM) Gynecology, Foshan Fosun Chancheng Hospital","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1001\/jama.2025.2975","article-title":"Endometriosis: a review","volume":"334","author":"As-Sanie","year":"2025","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2021.04.041","article-title":"Endometriosis: etiology, pathobiology, and therapeutic prospects","volume":"184","author":"Saunders","year":"2021","journal-title":"Cell"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: clinical challenges and novel innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-070750","article-title":"Pathophysiology, diagnosis, and management of endometriosis","volume":"379","author":"Horne","year":"2022","journal-title":"BMJ"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s0015-0282(97)81391-x","article-title":"Revised American Society for Reproductive Medicine classification of endometriosis: 1996","volume":"67","year":"1997","journal-title":"Fertil Steril"},{"key":"B7","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.tcm.2015.12.001","article-title":"Tissue factor as a link between inflammation and coagulation","volume":"26","author":"Witkowski","year":"2016","journal-title":"Trends Cardiovasc Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.117.309846","article-title":"Tissue factor: an essential mediator of hemostasis and trigger of thrombosis","volume":"38","author":"Grover","year":"2018","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1434.008","article-title":"Endometriosis and tissue factor","volume":"1127","author":"Krikun","year":"2008","journal-title":"Ann N Y Acad Sci"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2009.06.013","article-title":"Tissue factor and the endometrium: from physiology to pathology","volume":"124","author":"Krikun","year":"2009","journal-title":"Thromb Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2741\/4431","article-title":"Inflammation and endometriosis","volume":"21","author":"Jiang","year":"2016","journal-title":"Front Biosci (Landmark Ed)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2023.08.014","article-title":"Fibrinogen and fibrin: synthesis, structure, and function in health and disease","volume":"21","author":"Wolberg","year":"2023","journal-title":"J Thromb Haemost"},{"key":"B13","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.rbmo.2019.07.002","article-title":"Fibrinogen alpha chain is up-regulated and affects the pathogenesis of endometriosis","volume":"39","author":"Chen","year":"2019","journal-title":"Reprod BioMed Online"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.791860","article-title":"FGA controls VEGFA secretion to promote angiogenesis by activating the VEGFR2-FAK signalling pathway","volume":"13","author":"Li","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/biolre\/ioaa126","article-title":"Fibrinogen alpha chain promotes the migration and invasion of human endometrial stromal cells in endometriosis through focal adhesion kinase\/protein kinase B\/matrix metallopeptidase 2 pathway","volume":"103","author":"Li","year":"2020","journal-title":"Biol Reprod"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1177\/1933719115572478","article-title":"Evidence for a hypercoagulable state in women with ovarian endometriomas","volume":"22","author":"Wu","year":"2015","journal-title":"Reprod Sci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/1933719118799195","article-title":"Further evidence for hypercoagulability in women with ovarian endometriomas","volume":"25","author":"Ding","year":"2018","journal-title":"Reprod Sci"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/1933719117718273","article-title":"Coagulation status in women with endometriosis","volume":"25","author":"Vigano","year":"2018","journal-title":"Reprod Sci"},{"key":"B19","article-title":"Diagnostic and prognostic value of coagulation-related factors in endometriosis","volume":"14","author":"Ling","year":"2022","journal-title":"Am J Transl Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1186\/s12905-019-0860-9","article-title":"Is there a correlation between inflammatory markers and coagulation parameters in women with advanced ovarian endometriosis","volume":"19","author":"Ding","year":"2019","journal-title":"BMC Womens Health"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v9.i35.10805","article-title":"Blood tests for prediction of deep endometriosis: a case-control study","volume":"9","author":"Chen","year":"2021","journal-title":"World J Clin cases"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.21037\/apm-21-481","article-title":"Noninvasive evaluation of ovarian endometriosis: a single-center experience","volume":"10","author":"Zhao","year":"2021","journal-title":"Ann Palliat Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1186\/s12905-024-03227-4","article-title":"The coagulation status in women of endometriosis with stage IV","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Womens Health"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-025-03157-4","article-title":"The abnormal coagulation status in endometriosis patients: a systematic review and meta-analysis","volume":"59","author":"Zeng","year":"2026","journal-title":"J Thromb Thrombolysis"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1929933\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:25Z","timestamp":1789014745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1929933\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":24,"alternative-id":["10.3389\/fendo.2026.1929933"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1929933","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1929933"}}