{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:12:34Z","timestamp":1791846754103,"version":"4.3.4"},"reference-count":119,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Endometriosis affects 10\u201315% of reproductive-aged women and is a leading cause of infertility through anatomical, inflammatory, and molecular mechanisms. Objective: This review synthesizes current evidence on the pathophysiology of endometriosis-associated infertility and evaluates medical, surgical, and ART strategies to guide individualized management. Methods: We conducted a narrative review (2000\u20132025; PubMed, Scopus, WoS) synthesizing RCTs, meta-analyses, and observational studies on mechanisms and treatment outcomes. Results: In rASRM stage III\u2013IV, tubo-ovarian distortion and adhesions mechanically impair oocyte pickup and embryo transport. In superficial disease, animal models demonstrate that peritoneal inflammatory mediators and ROS can impair oocyte maturation, though direct causal evidence in humans is lacking. Epigenetic dysregulation has been identified in the eutopic endometrium and linked to progesterone resistance, though its direct causal role in infertility remains unestablished. Hormonal suppression controls pain but does not improve spontaneous conception rates. Laparoscopic surgery in stage I\u2013II remains debated. Prospective evidence supporting fertility benefit from DIE excision without mechanical obstruction is lacking. Cystectomy consistently reduces AMH, favoring IVF over surgery unless symptoms or retrieval barriers exist. IVF\/ICSI live birth rates per cycle in stage I\u2013II are comparable to those without endometriosis; cumulative rates after \u22645 cycles reach 43\u201346% in treated vs. 28% in untreated stage III\u2013IV patients. Conclusions: Management requires two sequential decisions: first, whether to perform a diagnostic laparoscopy to identify minimal disease and adhesions, and second, whether to proceed with surgery or transfer directly to ART. Age \u2265 35, infertility &gt; 2 years, or low AMH\/AFC favor immediate IVF. Post-surgical EFI guides timing: high EFI supports expectant management or IUI; low EFI should prompt ART referral. When cystectomy is necessary, tissue-sparing techniques should be prioritized and fertility preservation, including oocyte cryopreservation, discussed preoperatively.<\/jats:p>","DOI":"10.3390\/jcm15114297","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:25:31Z","timestamp":1780399531000},"page":"4297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endometriosis-Associated Infertility: A Review of Pathophysiological Mechanisms and Current Treatment Strategies"],"prefix":"10.3390","volume":"15","author":[{"given":"Magdalena","family":"Gniadek","sequence":"first","affiliation":[{"name":"Student Scientific Group of Obstetric and Gynecology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9913-9350","authenticated-orcid":false,"given":"Alina","family":"Porubenska","sequence":"additional","affiliation":[{"name":"Student Scientific Group of Obstetric and Gynecology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Pe\u0142ka","sequence":"additional","affiliation":[{"name":"Student Scientific Group of Obstetric and Gynecology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1950-7302","authenticated-orcid":false,"given":"Zuzanna","family":"Rzepkowska","sequence":"additional","affiliation":[{"name":"Student Scientific Group of Obstetric and Gynecology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"Florja\u0144ski","sequence":"additional","affiliation":[{"name":"University Centre of Obstetrics and Gynecology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1007\/s00404-025-08124-1","article-title":"Endometriosis and infertility: Pathophysiology, treatment strategies, and reproductive outcomes","volume":"312","author":"Elizur","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Genazzani, A.R., Nisolle, M., Petraglia, F., and Taylor, R.N. (2021). Endometriosis and infertility: Surgery and IVF: When, why, and outcomes. Endometriosis Pathogenesis, Clinical Impact and Management, Springer.","DOI":"10.1007\/978-3-030-57866-4"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"deae108.058","DOI":"10.1093\/humrep\/deae108.058","article-title":"O-056 can we tailor ART to endometriosis patients?","volume":"39","author":"Mijatovic","year":"2024","journal-title":"Hum. Reprod."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/00001703-200010000-00006","article-title":"Endometriosis-associated infertility","volume":"12","author":"Buyalos","year":"2000","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Horton, J., Lane, S., and Cheong, Y. (2025). Peritoneal fluid modulates redox balance and RNA integrity in mouse oocytes: Insights into endometriosis-related oxidative stress. Antioxidants, 14.","DOI":"10.3390\/antiox14081018"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e70179","DOI":"10.1111\/aji.70179","article-title":"Reframing endometriosis: Interplay of NETs, macrophages, and lymphocytes at the crossroads of disease progression, infertility, and malignant transformation","volume":"94","author":"Anchan","year":"2025","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s12964-024-01683-x","article-title":"The IL-33-ST2 axis plays a vital role in endometriosis via promoting epithelial\u2013mesenchymal transition by phosphorylating \u03b2-catenin","volume":"22","author":"Ruan","year":"2024","journal-title":"Cell Commun. Signal."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29282","DOI":"10.1038\/s41598-025-13618-8","article-title":"H3K27me3-mediated epigenetic regulation of TET1 in the eutopic endometrium of women with endometriosis and infertility","volume":"15","author":"Adamczyk","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_9","first-page":"497","article-title":"Manejo y abordaje de la infertilidad asociada a la endometriosis","volume":"71","author":"Garnier","year":"2014","journal-title":"Rev. Med. Costa Rica Centroam."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/path.4695","article-title":"Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions","volume":"239","author":"Sandoval","year":"2016","journal-title":"J. Pathol."},{"key":"ref_11","first-page":"CD000155","article-title":"Ovulation suppression for endometriosis","volume":"2007","author":"Hughes","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.fertnstert.2019.09.031","article-title":"Interventions for endometriosis-related infertility: A systematic review and network meta-analysis","volume":"113","author":"Hodgson","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_13","first-page":"CD011031","article-title":"Laparoscopic surgery for endometriosis","volume":"2020","author":"Bafort","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.fertnstert.2023.03.018","article-title":"Association of endometriosis and adenomyosis with pregnancy and infertility","volume":"119","author":"Vercellini","year":"2023","journal-title":"Fertil. Steril."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/S0015-0282(97)81391-X","article-title":"Revised American Society for Reproductive Medicine classification of endometriosis: 1996","volume":"67","author":"Canis","year":"1997","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.1210\/jc.2012-1558","article-title":"The impact of excision of ovarian endometrioma on ovarian reserve: A systematic review and meta-analysis","volume":"97","author":"Raffi","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/s-0035-1567820","article-title":"The impact of endometriosis and its treatment on ovarian reserve","volume":"33","author":"Seyhan","year":"2015","journal-title":"Semin. Reprod. Med."},{"key":"ref_19","first-page":"CD009590","article-title":"Endometriosis: An overview of Cochrane Reviews","volume":"10","author":"Brown","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1056\/NEJM199707243370401","article-title":"Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis","volume":"337","author":"Marcoux","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.fertnstert.2009.09.035","article-title":"Endometriosis fertility index: The new, validated endometriosis staging system","volume":"94","author":"Adamson","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/humupd\/dmv035","article-title":"The impact of endometrioma on IVF\/ICSI outcomes: A systematic review and meta-analysis","volume":"21","author":"Hamdan","year":"2015","journal-title":"Hum. Reprod. Update"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7265238","DOI":"10.1155\/2017\/7265238","article-title":"Oxidative stress and endometriosis: A systematic review of the literature","volume":"2017","author":"Scutiero","year":"2017","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Qi, Q., Li, Y., Chen, Z., Luo, Z., Zhou, T., Zhou, J., Zhang, Y., Chen, S., and Wang, L. (2025). Update on the pathogenesis of endometriosis-related infertility based on contemporary evidence. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1558271"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.fertnstert.2004.04.040","article-title":"The presence of endometrial cells in the peritoneal cavity enhances monocyte recruitment and induces inflammatory cytokines in mice: Implications for endometriosis","volume":"82","author":"Cao","year":"2004","journal-title":"Fertil. Steril."},{"key":"ref_26","first-page":"e98839","article-title":"Regulatory T-cells in reproductive medicine: Implications for endometriosis-associated infertility and implantation immunity","volume":"17","author":"Taguchi","year":"2025","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bouet, P.E., Chao de la Barca, J.M., Boucret, L., Descamps, P., Legendre, G., El Hachem, H., Blanchard, S., Jeannin, P., Reynier, P., and May-Panloup, P. (2020). Elevated levels of monocyte chemotactic protein-1 in the follicular fluid reveals different populations among women with severe endometriosis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051306"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"hoad033","DOI":"10.1093\/hropen\/hoad033","article-title":"The role of iron in the pathogenesis of endometriosis: A systematic review","volume":"2023","author":"Wyatt","year":"2023","journal-title":"Hum. Reprod. Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.ajpath.2025.08.016","article-title":"Decreased glycolysis due to lactate dehydrogenase A N6-methyladenosine methylation in endometrium of endometriosis impairs its decidualization and contributes to related infertility","volume":"195","author":"Weng","year":"2025","journal-title":"Am. J. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Dymanowska-Dyjak, I., Frankowska, K., Abramiuk, M., and Polak, G. (2024). Oxidative imbalance in endometriosis-related infertility\u2014The therapeutic role of antioxidants. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25126298"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zhong, Y., Qiao, X., Huang, X., Li, Y., Wang, R., Liang, J., Liu, T., Bo, W., Lai, H., and Huang, W. (2025). The effects of antioxidant supplementation on pain, oxidative stress markers, and clinical pregnancy rate in women with endometriosis: A systematic review and meta-analysis of randomized controlled trials. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1694281"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43416","DOI":"10.1038\/s41598-025-20319-9","article-title":"Impact of endometrioma on iron levels and oxidative stress in the follicular fluid in women with endometriosis: A cross-sectional study","volume":"15","author":"Peter","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s40659-025-00641-2","article-title":"Endometriosis-associated infertility alters the microRNA signatures of cumulus cells with a particularly pronounced effect in oocytes that failed fertilization","volume":"58","author":"Makieva","year":"2025","journal-title":"Biol. Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Surmann, H., and Kiesel, L. (2025). The role of miRNA in endometriosis-related infertility\u2014An update. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26125862"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E363","DOI":"10.1503\/cmaj.220637","article-title":"Diagnosis and management of endometriosis","volume":"195","author":"Allaire","year":"2023","journal-title":"Can. Med. Assoc. J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Koninckx, P.R., Fernandes, R., Ussia, A., Schindler, L., Wattiez, A., Al-Suwaidi, S., Amro, B., Al-Maamari, B., Hakim, Z., and Tahlak, M. (2021). Pathogenesis based diagnosis and treatment of endometriosis. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.745548"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1080\/13697137.2023.2190882","article-title":"Evaluation and management of endometriosis","volume":"26","author":"Yoldemir","year":"2023","journal-title":"Climacteric"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e061","DOI":"10.1097\/og9.0000000000000061","article-title":"Diagnostic accuracy of transvaginal ultrasonography for endometriosis according to the international deep endometriosis analysis consensus","volume":"2","author":"Mick","year":"2025","journal-title":"O&G Open"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Bonavina, G., and Taylor, H.S. (2022). Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1020827"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ogc.2012.10.002","article-title":"Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility","volume":"39","author":"Macer","year":"2012","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/1471-0528.15880","article-title":"Reproducibility of the endometriosis fertility index: A prospective inter-\/intra-rater agreement study","volume":"127","author":"Tomassetti","year":"2020","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e16965","DOI":"10.1097\/MD.0000000000016965","article-title":"Fertility performance and the predictive value of the endometriosis fertility index staging system in women with recurrent endometriosis: A retrospective study","volume":"98","author":"Zhou","year":"2019","journal-title":"Medicine"},{"key":"ref_43","unstructured":"National Institute for Health and Care Excellence (NICE) (2026, January 10). Endometriosis: Diagnosis and Management (NG73). 2017. (Updated 2024). Available online: https:\/\/www.nice.org.uk\/guidance\/ng73."},{"key":"ref_44","first-page":"541","article-title":"Non-steroidal anti-inflammatory drugs (NSAIDs) and ovulation: Lessons from morphology","volume":"21","author":"Morales","year":"2006","journal-title":"Histol. Histopathol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1056\/NEJMra0804690","article-title":"Endometriosis","volume":"360","author":"Bulun","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.xfre.2022.11.009","article-title":"GnRH agonists in the treatment of symptomatic endometriosis: A review","volume":"4","author":"Surrey","year":"2022","journal-title":"F&S Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1080\/13543784.2020.1842356","article-title":"Aromatase inhibitors for the treatment of endometriosis: A systematic review about efficacy, safety and early clinical development","volume":"29","author":"Garzon","year":"2020","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Piriyev, E., Schiermeier, S., and R\u00f6mer, T. (2025). Hormonal treatment of endometriosis: A narrative review. Pharmaceuticals, 18.","DOI":"10.3390\/ph18040588"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1196\/annals.1335.035","article-title":"Surgical management of deeply infiltrating endometriosis: An update","volume":"1034","author":"Chapron","year":"2004","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.1007\/s43032-024-01660-2","article-title":"Holistic approaches in endometriosis as an effective method of supporting traditional treatment: A systematic search and narrative review","volume":"31","author":"Tim","year":"2024","journal-title":"Reprod. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/GCO.0000000000000710","article-title":"Assisted reproductive technology for women with endometriosis: A clinically oriented review","volume":"33","author":"Ata","year":"2021","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/S0140-6736(10)60490-4","article-title":"Endometriosis and infertility: Pathophysiology and management","volume":"376","author":"Borghese","year":"2010","journal-title":"Lancet"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1056\/NEJMoa1700089","article-title":"Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist","volume":"377","author":"Taylor","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.fertnstert.2018.03.012","article-title":"Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: A systematic review of the evidence","volume":"110","author":"Jensen","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_55","first-page":"CD001019","article-title":"Oral contraceptives for pain associated with endometriosis","volume":"2018","author":"Brown","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/S0015-0282(03)00794-5","article-title":"Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen","volume":"80","author":"Vercellini","year":"2003","journal-title":"Fertil. Steril."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ajog.2015.08.074","article-title":"Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: A systematic review and metaanalysis","volume":"214","author":"Muzii","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ejogrb.2025.01.033","article-title":"Clinical effectiveness of progestogens compared to combined oral contraceptive pills in the treatment of endometriosis: A systematic review and meta-analysis","volume":"306","author":"Kemczenski","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Kaveh, M., Chaichian, S., Mehdizadeh Kashi, A., Mohsenikia, M., Afrouzeh, M., and Sadegi, K. (2025). Comparison of quality of life in patients with endometriosis undergoing treatment with progestins, oral contraceptives pills (OCP), and GnRH agonists. BMC Womens Health, 25.","DOI":"10.1186\/s12905-025-03937-3"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.ejogrb.2021.10.029","article-title":"Efficacy of dienogest vs combined oral contraceptive on pain associated with endometriosis: Randomized clinical trial","volume":"267","author":"Khalifeh","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11154-021-09666-w","article-title":"Hormonal treatments for endometriosis: The endocrine background","volume":"23","author":"Vannuccini","year":"2022","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3135","DOI":"10.1007\/s43032-023-01266-0","article-title":"The efficacy of dienogest in reducing disease and pain recurrence after endometriosis surgery: A systematic review and meta-analysis","volume":"30","author":"Muzii","year":"2023","journal-title":"Reprod. Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1177\/0300060513479865","article-title":"Analysis of the levonorgestrel-releasing intrauterine system in women with endometriosis","volume":"41","author":"Lan","year":"2013","journal-title":"J. Int. Med. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1517\/14656566.2014.888414","article-title":"A comparison of progestogens or oral contraceptives and gonadotropin-releasing hormone agonists for the treatment of endometriosis: A systematic review","volume":"15","author":"Jeng","year":"2014","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1517\/14740338.2016.1121991","article-title":"Safety of medical treatments for endometriosis","volume":"15","author":"Berlanda","year":"2016","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_66","first-page":"CD008475","article-title":"Gonadotrophin-releasing hormone analogues for pain associated with endometriosis","volume":"2010","author":"Brown","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"337","DOI":"10.2217\/cer-2018-0124","article-title":"Cost-effectiveness of elagolix versus leuprolide acetate for treating moderate-to-severe endometriosis pain in the USA","volume":"8","author":"Wang","year":"2019","journal-title":"J. Comp. Eff. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.bpobgyn.2018.01.021","article-title":"From pathogenesis to clinical practice: Emerging medical treatments for endometriosis","volume":"51","author":"Clemenza","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.fertnstert.2005.12.030","article-title":"Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain","volume":"86","author":"Bedaiwy","year":"2006","journal-title":"Fertil. Steril."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s00404-014-3230-8","article-title":"Clinical efficacy of add-back therapy in treatment of endometriosis: A meta-analysis","volume":"290","author":"Wu","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"114093","DOI":"10.1016\/j.ejogrb.2025.114093","article-title":"GnRH analogues and dienogest for second line treatment of endometriosis-associated pain: A systematic review, meta-analysis, and network meta-analysis","volume":"312","author":"Dick","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0015-0282(16)56039-7","article-title":"A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis","volume":"60","author":"Vercellini","year":"1993","journal-title":"Fertil. Steril."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ejogrb.2015.06.006","article-title":"Effects of low dose oral contraceptive pill containing drospirenone\/ethinylestradiol in patients with endometrioma","volume":"191","author":"Taniguchi","year":"2015","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: Pathogenesis and treatment","volume":"10","author":"Vercellini","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/AOG.0000000000002469","article-title":"Clinical management of endometriosis","volume":"131","author":"Falcone","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.fertnstert.2017.01.003","article-title":"Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills","volume":"107","author":"Casper","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jmig.2013.01.019","article-title":"Combined surgical and hormone therapy for endometriosis is the most effective treatment: Prospective, randomized, controlled trial","volume":"20","author":"Alkatout","year":"2013","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/aogs.13369","article-title":"Questionnaire-based evaluation of sexual life after laparoscopic surgery for endometriosis: A systematic review of prospective studies","volume":"97","author":"Franck","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jmig.2018.09.774","article-title":"Surgery for endometriosis improves major domains of quality of life: A systematic review and meta-analysis","volume":"26","author":"Borrelli","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Enciu, R.G., Enciu, O., Georgescu, D.E., Tulin, A., and Miron, A. (2024). Is complete excision always enough? A quality of sexual life assessment in patients with deep endometriosis. Medicina, 60.","DOI":"10.3390\/medicina60091534"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.jmig.2014.04.002","article-title":"To excise or ablate endometriosis? A prospective randomized double-blinded trial after 5-year follow-up","volume":"21","author":"Healey","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/j.fertnstert.2004.04.067","article-title":"A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas","volume":"82","author":"Alborzi","year":"2004","journal-title":"Fertil. Steril."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.jmig.2019.07.027","article-title":"Recurrence rate after \u201cone-step\u201d CO2 fiber laser vaporization versus cystectomy for ovarian endometrioma: A 3-year follow-up study","volume":"27","author":"Candiani","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.fertnstert.2011.04.068","article-title":"Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: A randomized clinical trial with a five-year follow-up","volume":"96","author":"Carmona","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.rbmo.2022.02.024","article-title":"Similar long-term recurrence rates with cystectomy and CO2 laser vaporization for endometrioma: A retrospective study","volume":"45","author":"Bafort","year":"2022","journal-title":"Reprod. Biomed. Online"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1179558119873386","DOI":"10.1177\/1179558119873386","article-title":"Fertility preservation in women with endometriosis","volume":"13","author":"Llarena","year":"2019","journal-title":"Clin. Med. Insights Reprod. Health"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1093\/humupd\/dmy049","article-title":"Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: A systematic review and meta-analysis","volume":"25","author":"Younis","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/humupd\/dmq057","article-title":"Surgical treatment of deeply infiltrating endometriosis with colorectal involvement","volume":"17","author":"Meuleman","year":"2011","journal-title":"Hum. Reprod. Update"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/humupd\/dmz012","article-title":"Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: A systematic review and meta-analysis","volume":"25","author":"Horton","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"43","DOI":"10.23736\/S0026-4784.20.04490-1","article-title":"Treatment algorithm for women with endometriosis in a certified Endometriosis Unit","volume":"72","author":"Findeklee","year":"2020","journal-title":"Minerva Ginecol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Working Group of ESGE, ESHRE and WES, Keckstein, J., Becker, C.M., Canis, M., Feki, A., Grimbizis, G.F., Hummelshoj, L., Nisolle, M., Saridogan, E., and Tanos, V. (2020). Recommendations for the surgical treatment of endometriosis. Part 2: Deep endometriosis. Hum. Reprod. Open, 2020, 269\u2013297.","DOI":"10.1093\/hropen\/hoaa002"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.bpobgyn.2020.06.011","article-title":"Fertility preservation in women for medical and social reasons: Oocytes vs ovarian tissue","volume":"70","author":"Dolmans","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"100017","DOI":"10.1016\/j.jeud.2023.100017","article-title":"Elective oocyte freezing for fertility preservation in endometriosis: Opportunity or resource wastage?","volume":"1","author":"Benaglia","year":"2023","journal-title":"J. Endometr. Uterine Disord."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.fertnstert.2015.08.026","article-title":"Prevention of the recurrence of symptoms and lesions after conservative surgery for endometriosis","volume":"104","author":"Koga","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.rbmo.2020.09.018","article-title":"Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence","volume":"42","author":"Capezzuoli","year":"2021","journal-title":"Reprod. Biomed. Online"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/AOG.0b013e31824264c3","article-title":"Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: A randomized controlled trial","volume":"119","author":"Tanmahasamut","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jmig.2020.08.015","article-title":"Surgical outcomes after colorectal surgery for endometriosis: A systematic review and meta-analysis","volume":"28","author":"Bendifallah","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_98","first-page":"213","article-title":"Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter","volume":"24","author":"Fernandes","year":"2014","journal-title":"Surg. Technol. Int."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1111\/1471-0528.16328","article-title":"Effect of hysterectomy on pain in women with endometriosis: A population-based registry study","volume":"127","author":"Bixo","year":"2020","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1097\/AOG.0b013e3181758ec6","article-title":"Surgical treatment of endometriosis: A 7-year follow-up on the requirement for further surgery","volume":"111","author":"Shakiba","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/j.1471-0528.2005.00696.x","article-title":"The association of hysterectomy and menopause: A prospective cohort study","volume":"112","author":"Farquhar","year":"2005","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_102","first-page":"219","article-title":"Recurrence of endometriosis after hysterectomy","volume":"6","author":"Rizk","year":"2014","journal-title":"Facts Views Vis. Obgyn."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.tjog.2013.02.004","article-title":"Laparoscopic surgery for subfertility related to endometriosis: A meta-analysis","volume":"53","author":"Jin","year":"2014","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/rmb2.12286","article-title":"The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies","volume":"18","author":"Alborzi","year":"2019","journal-title":"Reprod. Med. Biol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"103186","DOI":"10.1016\/j.rbmo.2023.02.012","article-title":"Impact of moderate-to-severe endometriosis on IVF cumulative live birth rate: A retrospective matched cohort study","volume":"47","author":"Zimmermann","year":"2023","journal-title":"Reprod. Biomed. Online"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.fertnstert.2006.01.044","article-title":"No difference in cycle pregnancy rate and in cumulative live-birth rate between women with surgically treated minimal to mild endometriosis and women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination","volume":"86","author":"Werbrouck","year":"2006","journal-title":"Fertil. Steril."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s10815-018-1214-5","article-title":"Endometriosis does not affect live birth rates of patients submitted to assisted reproduction techniques: Analysis of the Latin American Network Registry database from 1995 to 2011","volume":"35","author":"Murta","year":"2018","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/AOG.0000000000000592","article-title":"Influence of endometriosis on assisted reproductive technology outcomes: A systematic review and meta-analysis","volume":"125","author":"Hamdan","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_109","first-page":"288","article-title":"Prognostic factors for IVF\u2013ICSI live birth rate in women with endometriosis-related infertility","volume":"79","author":"Tew","year":"2024","journal-title":"Med. J. Malays."},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Zhong, C., Gao, L., Shu, L., Hou, Z., Cai, L., Huang, J., Liu, J., and Mao, Y. (2021). Analysis of IVF\/ICSI outcomes in endometriosis patients with recurrent implantation failure: Influence on cumulative live birth rate. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.640288"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1093\/humrep\/deaf184","article-title":"Cumulative live birth rates under three consecutive IVF\/ICSI treatment cycles are reduced in women with endometriosis and\/or adenomyosis diagnosed by ultrasonography","volume":"40","author":"Alson","year":"2025","journal-title":"Hum. Reprod."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s00404-025-08039-x","article-title":"Ovarian damage following surgery for endometriomas, 20 years later: Did awareness improve the situation?","volume":"312","author":"Invernici","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e12654","DOI":"10.1002\/rmb2.12654","article-title":"Effect of embryo cryopreservation before surgery on clinical outcomes in IVF patients with endometrioma","volume":"24","author":"Takahashi","year":"2025","journal-title":"Reprod. Med. Biol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"651","DOI":"10.7150\/ijms.69830","article-title":"Long-Term Follow-Up of Anti-Mullerian Hormone Levels After Laparoscopic Endometrioma Cystectomy","volume":"19","author":"Nguyen","year":"2022","journal-title":"Int. J. Med. Sci."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13048-020-00622-x","article-title":"Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization\u2013embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: A retrospective study","volume":"13","author":"Zhao","year":"2020","journal-title":"J. Ovarian Res."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.fertnstert.2019.12.018","article-title":"Ultralong administration of gonadotropin-releasing hormone agonists before in vitro fertilization improves fertilization rate but not clinical pregnancy rate in women with mild endometriosis: A prospective, randomized, controlled trial","volume":"113","author":"Kaponis","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"4377","DOI":"10.12659\/MSM.916447","article-title":"Efficacy and Safety of In Vitro Fertilization (IVF)\/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation","volume":"25","author":"Kong","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"102429","DOI":"10.1016\/j.bpobgyn.2023.102429","article-title":"IVF stimulation protocols and outcomes in women with endometriosis","volume":"92","author":"Goyri","year":"2024","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Sun, Q., Cao, Y., Gu, J., and Xu, Y. (2025). The application of progesterone-primed ovarian stimulation protocol in patients with ovarian endometriosis combined with diminished ovarian reserve. 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