{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:02:06Z","timestamp":1785423726102,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila, Doctoral School"},{"id":[{"id":"https:\/\/ror.org\/04fm87419","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To evaluate reproductive outcomes following fertility-sparing surgery for deep endometriosis (DE), specifically assessing the impact of bowel resection on spontaneous conception rates and the predictive value of the Endometriosis Fertility Index (EFI). Design: Retrospective observational cohort study. Setting: High-volume tertiary referral center for endometriosis. Patients: A total of 507 women with histologically confirmed endometriosis and documented infertility or active desire for pregnancy, managed between 2018 and 2025. Patients undergoing hysterectomy were excluded. Interventions: Laparoscopic complete excision of endometriotic lesions using a nerve-sparing technique. The surgical strategy for bowel involvement was tailored to nodule characteristics: 194 patients (38.3%) underwent segmental colorectal resection, 38 (7.5%) underwent rectal shaving, and 9 (1.8%) were treated with advanced organ-sparing techniques (lateral rectal resection or extra-mucosal excision\u2014EMEB). Main Outcome Measures: Postoperative pregnancy rate (PR), mode of conception (spontaneous vs. ART), and factors influencing fertility. Results: The cohort presented with severe disease (mean rASRM stage 3.4) and a high prevalence of primary infertility (79.3%). During the follow-up period, 310 patients achieved pregnancy, resulting in an overall pregnancy rate of 61.1%. Notably, 70.3% of these pregnancies were achieved spontaneously. Radicality did not compromise fertility: the segmental resection group achieved a pregnancy rate of 91.2% (177\/194), while patients treated with rectal shaving achieved 100%. The EFI score was identified as a robust predictor of success (mean score 5.5 in pregnant vs. 4.9 in non-pregnant patients, p &lt; 0.05). Conclusions: Comprehensive nerve-sparing excision of DE, including segmental bowel resection, is associated with high pregnancy rates and a predominant restoration of natural fertility. Surgery should be considered a first-line strategy to reduce dependency on assisted reproductive technologies.<\/jats:p>","DOI":"10.3390\/jcm15145384","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:55:32Z","timestamp":1783598132000},"page":"5384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reproductive Outcomes Following Minimally Invasive Surgery for Deep Endometriosis: A Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Andrei","family":"Manu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6414-0841","authenticated-orcid":false,"given":"Elena","family":"Poenaru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9288-5309","authenticated-orcid":false,"given":"Arina-Ilinca","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2874-1674","authenticated-orcid":false,"given":"Smaranda","family":"Stoleru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7764-7839","authenticated-orcid":false,"given":"Alexandra Irma Gabriela","family":"Bau\u0219ic","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"},{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-0663","authenticated-orcid":false,"given":"Bogdan-C\u0103t\u0103lin","family":"Coroleuc\u0103","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2043-9307","authenticated-orcid":false,"given":"Ciprian-Andrei","family":"Coroleuc\u0103","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"},{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina-Maria","family":"Iacob","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela Arina","family":"Banu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca-Mihaela","family":"Hashemi","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"},{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Bianca","family":"Ni\u021bescu","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Obstetrics and Gynecology \u201cProf. Dr. Panait S\u00eerbu\u201d, 060251 Bucharest, Romania"},{"name":"Faculty of Medicine, \u201cCarol 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Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","unstructured":"Becker, C.M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., and Petersen, K. 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