Interaction between endometrial stromal cells and extracellular matrix (ECM) components has a crucial role in the development of endometriosis. Endometrial stromal cells attach to the mesothelial surface of peritoneum by means of integrins during their initial implantation and growth in endometriosis. Similarly, interaction between integrin and the extracellular matrix is also crucial for the remodeling of the endometrium during early pregnancy. We hypothesized that adhesion of endometrial stromal cells to the extracellular matrix could suppress the immunologic reaction to implanting endometrial cells by inducing the expression of Fas ligand (FasL), a mediator of the apoptotic pathway. Western blot analysis of human endometrial stromal cells plated onto fibronectin, laminin, and collagen IV revealed higher levels of FasL protein expression compared with endometrial stromal cells that plated to BSA-coated plates (control). Immunocytochemistry results from endometrial stromal cells plated to extracellular matrix proteins demonstrated a similar up-regulation of FasL expression. Eutopic endometrial stromal cells from women with endometriosis demonstrated higher FasL expression on control plates and those coated with extracellular matrix proteins compared with those from women without endometriosis. Disruption of actin cytoskeleton in endometrial stromal cells by treatment with cytochalasin D blocked the increase of FasL protein expression that occurred in response to adhesion to the extracellular matrix. These results suggest that attachment of endometrial stromal cells during retrograde menstruation to a new environment such as peritoneum with increased expression of laminin, fibronectin, and collagen IV could lead to an increase in FasL expression. Induction of FasL expression by adhesion of endometrial stromal cells to the extracellular matrix may take part in the development of a relative immunotolerance by inducing apoptosis of cytotoxic T lymphocytes, which will allow further development of ectopic implants.