Abstract
Background:
Endometriosis can disrupt folliculogenesis due to elevated levels of pro-inflammatory cytokines, free radicals, and the apoptotic response in granulosa cells. So it can cause fertility issues in women. To date, the best effective management strategy to address it has not been identified. The root extract of Saussurea lappa, also known as pucuk or kusth (Indonesia), can reduce tumour necrosis factor (TNF-α) levels, inhibit reactive oxygen species (ROS), and prevent apoptosis in granulosa cells, thereby enhancing folliculogenesis.

Aim:
This study aims to assess the effects of a 70% ethanol extract of Saussurea lappa on F2-isoprostane, TNF-α, and apoptosis in the granulosa cells of primary, secondary, and tertiary follicles in a mice model of endometriosis, potentially improving folliculogenesis.

Methods:
The desiccated root of Saussurea lappa was transformed into a 70% ethanol extract. Thirty-two mice were utilized to establish the endometriosis model and were divided into four groups: one control group (K1) and three treatment groups administered Saussurea lappa extract orally at doses of 200 (K2), 400 (K3), and 600 (K4) mg/kg. An assessment of F2-isoprostane, TNF-α, and apoptosis was conducted on granulosa cells obtained from primary, secondary, and tertiary follicles. The counts of primary, secondary, and tertiary follicles are also specified.

Results:
The research findings indicate (P < 0.05) that the concentrations of F2-isoprostane, TNF-α, and apoptosis in the granulosa cells of primary, secondary, and tertiary follicles diminished, whereas the follicle count augmented in all treatment groups (K2, K3, K4) administered Saussurea lappa extract in comparison to the control group (K1).

Conclusion:
Saussurea lappa reduces the concentrations of F2-isoprostane, tumor necrosis factor (TNF-α), and apoptosis in the granulosa cells of primary, secondary, and tertiary follicles, consequently enhancing folliculogenesis, characterized by an increase in the quantity of these follicles in a mice model of endometriosis.

Key words: Endometriosis; Granulosa cells; Folliculogenesis; Saussurea lappa.