Ovarian Endometriosis as a Cause of Impaired Fertility: Current Status and Prospects for Predicting Reproductive Outcome
Keywords:
Ovarian endometriosis, infertility, fertility, ovarian reserve, ovarian microenvironment, inflammation, oxidative stress, neurogenic inflammation, prognosis, EFIAbstract
Background. Ovarian endometriosis occupies a special place in the structure of endometriosis-associated infertility, as it directly affects ovarian tissue, ovarian reserve, and the microenvironment of the maturing oocyte. Despite the significant accumulated data on the clinical, anamnestic, hormonal, morphofunctional, inflammatory, oxidative, and neuroinflammatory mechanisms of impaired fertility, current approaches to assessing the reproductive prognosis in women with ovarian endometriosis remain insufficiently comprehensive. Study Objective. To analyze current understanding of the role of ovarian endometriosis in infertility, summarize data on the leading mechanisms of fertility decline, and identify unresolved issues in predicting reproductive outcome. Materials and Methods. A problem-based analytical review of the current literature on ovarian endometriosis, reproductive dysfunction, ovarian reserve, laparoscopic and instrumental disease assessment, the ovarian microenvironment, and the inflammatory, oxidative, and neuroinflammatory mechanisms of endometriosis-associated infertility was conducted. International clinical guidelines, World Health Organization guidelines, systematic reviews, meta-analyses, and clinical trials of the greatest scientific and practical significance were analyzed. Results: It was demonstrated that ovarian endometriosis should be considered a multifactorial cause of infertility, in which decreased fertility results from a complex interaction of clinical, anamnestic, hormonal, anatomical, morphological, inflammatory, oxidative, and neuroinflammatory mechanisms. It has been established that existing prognostic approaches, including EFI, have significant clinical value; however, they do not fully reflect the biological complexity of the disease, as they rely primarily on anamnestic and laparoscopic criteria and insufficiently consider the state of the ovarian reserve, the ovarian microenvironment, and the activity of inflammatory-oxidative processes. It has been revealed that one of the key unresolved issues remains the insufficient integration of known clinical and pathogenetic factors into a unified fertility assessment system
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