{"paper_id":"39504c50-3272-4cc4-a421-3d00aabe7b50","body_text":"INFERTILITY IN WOMEN WITH ENDOMETRIOSIS: MECHANISMS, BIOMARKERS AND CONTEMPORARY MANAGEMENT STRATEGIES – A REVIEW\nDOI:\nhttps://doi.org/10.31435/ijitss.1(49).2026.4840Keywords:\nEndometriosis, Infertility, Immune Dysregulation, GnRH Antagonists, Quality of LifeAbstract\nIntroduction: Endometriosis is a chronic inflammatory disorder that affects approximately 6–10% of women of reproductive age and is found in up to 50% of those assessed for infertility. While advanced stages of the disease can compromise fertility through the formation of adhesions and anatomical distortions, clinically significant infertility can also occur in cases of minimal or mild endometriosis, highlighting the role of non-anatomical factors. Current evidence suggests that immune dysregulation, progesterone resistance, chronic endometrial inflammation, oxidative stress, and microbiome disturbances contribute to impaired implantation and diminished reproductive potential.\nObjectives: This narrative review synthesizes current mechanistic and clinical evidence regarding endometriosis-related infertility, focusing on molecular pathways, evolving diagnostic methodologies, and fertility-oriented treatment strategies.\nMethods: We searched PubMed, Scopus, and Google Scholar for publications from 2018 to 2025 on endometriosis and infertility. Priority was given to international clinical guidelines, systematic reviews, meta-analyses, and original studies addressing pathophysiology, diagnostics, fertility interventions (including surgery and assisted reproduction), and quality-of-life outcomes. A narrative synthesis was performed.\nResults: Endometriosis shares key molecular and immunologic features with recurrent implantation failure, such as aberrant macrophage activation, T-cell imbalances, and impaired endometrial receptivity. Oral GnRH antagonists offer new options for symptom control while preserving flexibility in fertility planning. Emerging therapies target inflammation, immune pathways, and the endometrial microbiome. Ongoing trials (e.g., surgery-first vs. IVF-first) may identify optimal treatment sequences. However, delayed diagnosis and unequal access to fertility care remain major challenges worldwide.\nConclusions: Infertility associated with endometriosis is multifactorial and requires an individualized, multidisciplinary approach that integrates reproductive goals, symptom management, and psychosocial well-being. Further validation of biomarker panels and comparative-effectiveness studies is essential to refine clinical algorithms and enhance reproductive outcomes.\nReferences\nZondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. New England Journal of Medicine, 382(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764\nWang, Z., Ouyang, Y., Xue, Z., Wang, J., Gu, W., & Gu, C. (2025). Global, regional, and national burden and trends of endometriosis, 1990–2021: An analysis of the Global Burden of Disease Study 2021 and forecast to 2050. BMC Women’s Health, 25(1), 519. https://doi.org/10.1186/s12905-025-04043-0\nDe Corte, P., Klinghardt, M., von Stockum, S., & Heinemann, K. (2025). Time to diagnose endometriosis: Current status, challenges and regional characteristics—A systematic literature review. BJOG: An International Journal of Obstetrics & Gynaecology, 132(2), 118–130. https://doi.org/10.1111/1471-0528.17973\nRathod, S., Shanoo, A., & Acharya, N. (2024). 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Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1369317\nDownloads\nPublished\nIssue\nSection\nLicense\nCopyright (c) 2026 Barbara Tomaszek, Aleksandra Blok, Kamila Kapłon , Gabriela Kapłon, Dominika Gieroba, Anna Kamieniak , Remigiusz Flakus, Karolina Glajcar, Wiktor Werenkowicz\nThis work is licensed under a Creative Commons Attribution 4.0 International License.\nAll articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.\nCC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.","source_license":"CC0","license_restricted":false}