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Study Question: Does the methylation status of the promoter region of the HOXA10 gene differ in eutopic and ectopic endometrium?, Summary Answer: The eutopic endometrium in women with endometriosis is significantly more methylated when compared with controls., What Is Known Already: Expression of the HOXA10 gene, which is important for successful implantation, is reduced in women affected by endometriosis., Study Design, Size and Duration: A pilot study was carried out including 18 women admitted for surgery for endometriosis-related pain (cases) and 12 women admitted for surgery because of non-endometriotic disease (control). Sample collection and analysis were performed between November 2010 and July 2013., Participants/materials, Setting, Methods: Endometrial tissue (eutopic and ectopic) underwent sodium bisulfite DNA modification, PCR amplification of two regions of the HOXA10 promoter and pyrosequencing analysis., Main Results and the Role of Chance: The eutopic endometrium of women with endometriosis was significantly more methylated compared with endometrium from the control group (sequence 1: 8.68% in cases and 6.25% in the control group: P = 0.037, sequence 2: 11.89% in cases and 9.25% in the control group: P = 0.032). The eutopic endometrium was significantly more methylated than the ectopic tissue in patients with endometriosis (mean difference -3.6 sequence 1: P = 0.001 and -6.0 sequence 2: P = 0.0001)., Limitations, Reasons for Caution: The study had a limited sample size and the fertility status of the majority of patients in our study was unknown., Wider Implications of the Findings: Our data regarding methylation state of the ectopic tissues contribute to a better etiopathologic understanding of endometriosis., Study Funding/competing Interests: No external funding was either sought or obtained for this study. The authors have no conflicts of interests to declare., (© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

A decrease in HOXA10 gene expression in eutopic mid-secretory endometrium has been found in women with endometriosis-associated infertility. Promoter hypermethylation of HOXA10 is thought to be the leading mechanism for epigenetic gene regulation in patients with endometriosis. In our series we documented significantly higher HOXA10 promoter methylation levels in women with ovarian endometriomas than in healthy controls during the mid-luteal phase. Development of epigenetic-based strategies for non-surgical treatment of infertility related to ovarian endometriomas could be an attractive field of research in the coming years., (© 2013 Nordic Federation of Societies of Obstetrics and Gynecology.)