Furthermore, several mechanisms involving granulosa cells weredescribed for this group of patients, involving prolactin secretion, decreasedanti-Mullerian hormone and dysfunction in BMP-6 and SMAD4 in cumulus cells linked toperitoneal endometriosis (Cunha-Filho etal., 2001; 2003; De Conto et al., 2017; 2020). This evidence concerns the gene SMAD4 and endometriosis.