BACKGROUND Studies have shown that the concentration of interleukin (IL)-6 in peritoneal fluid is increased in patients with endometriosis; however, whether the disorders involving IL-6 contribute to the development of endometriosis is still unclear. In the present study, we evaluated the potential role of IL-6 and IL-6 receptor (IL-6R) in the pathogenesis of endometriosis. MATERIAL AND METHODS We examined activated macrophages and the expression of membrane-binding receptor (mIL-6R) in peritoneal fluid using flow cytometry. The levels of IL-6 and the IL-6 soluble receptor (sIL-6R) in peritoneal fluid and plasma in patients with endometriosis was measured by an enzyme-linked immunosorbent assay. RESULTS Activated macrophages and mIL-6R in peritoneal fluid were increased in patients with endometriosis. IL-6 and sIL-6R in peritoneal fluid were also increased in patients with endometriosis; however, there was an increase in plasma IL-6 and a decrease in plasma sIL-6R. The endometriosis group was categorized into 2 groups according to the retrospective American Fertility Society Score (r-AFS): group A and group B. Peritoneal fluid sIL-6R in endometriosis group B was significantly higher than in endometriosis group A and the control group. CONCLUSIONS Disorders involving IL-6 and IL-6R are correlated with the etiology of endometriosis. An increase in sIL-6R in peritoneal fluid promotes the development of endometriosis by enhancing the bioactivity of IL-6.