ATG5 and adenomyosis: Studies on adenomyosis patients and mouse models have revealed lower autophagy levels in the eutopic endometrium during the decidual phase and the implantation window compared to controls [15,28] This decrease in autophagy may be due to the abnormal expression of KLF4 in endometrial stromal cells, a factor known to regulate ATG5 expression and maintain normal autophagy and decidualization processes [15].