{"paper_id":"39d5f681-c699-4444-a698-44f225df17ae","body_text":"International Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 1 \n \nAn investigation into the relationship between \nendometriosis and the outcomes experienced by \ninfertile patients \n \nDr(Captain)Sunita Dhankhar \n \nPhD Scholar \nMangalayatan university, Beswan,Aligarh \n \nAbstract: \n \nIntroduction:  \nFemales of reproductive age have a 6 –10% prevalence of endometriosis. About 25 –35% of women who \nare infertile may have endometriosis. Treatment options for infertile patients vary according to the \ndisease's stage. It begins with an ovulation -inducing medication and progresses to sophisticated ART. \nThis study was out to evaluate the results of surgical treatment for pa tients with endometriosis who were \ninfertile. \nMaterials and Methods:  \nThe study was carried out in selected government hospitals at Haryana . A total of 1 50 patients between \nthe ages of 20 and 40 were included in this study . Every demographic factor, clini cal and sonographic \nresult, and hormonal evaluation was completed. Following that, staging was completed using \nultrasonographic results and a clinical pelvic evaluation. For laparoscopic surgery, patients with ovarian \nendometriomas larger than 4 cm were ch osen. Patients were chosen for ovulation induction with or \nwithout prior GnRH agonist therapy if their endometrioma measured less than 4 cm or if they did not \nhave an ovarian endometrioma. \nResults: The patients' mean age was 29.64 years  &  70.52% had primary infertility.  Dysmenorrhea  \n(76.24%)was the most important clinical symptom followed by Menorrhagia  \n(54.61%) and chronic pelvic (40.51%). Decreased serum AMH was linked to bilateral endometrioma. \nThe primary treatment was laparoscopic s urgery. The remaining patients received conservative care. In \norder to increase fertility, ovulation -inducing medications such as letrozole and GnRH agonists were \nused, followed by controlled ovarian stimulation and IUI. In 2 5 patients (33.33 %), IVF was \nrecommended for fertility management. In conclusion, endometriosis causes a reduced response to \novarian stimulation in addition to being linked to a decreased ovarian reserve. Therefore, obtaining \neffective reproductive treatment for this patient population is quite difficult. \n \n1. Introduction \n \nEndometriosis as a risk factor for natural conception The existence of endometrial glands outside the \nuterus is a hallmark of endometriosis, a persistent inflammatory illness. About 5 –10% of women who \nare of reproductive age are affected, and it frequently results in pelvic discomfort, decreased fertility, or \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 2 \n \nboth (Giudice, 2010). Up to 30–50% of women with endometriosis are infertile, which is a serious worry \n(Somigliana et al., 2017). Furthermore, up to 25 –50% of infertile individuals have endometriosis, which \nis ten times more common than in the general population (Ozkan et al., 2008; Koch et al., 2012); \nadditionally, endometriosis accounts for 10% of referrals for IVF treatments (Somigliana et al., 2017). \nThe connection between endometriosis and infertility has been explained by a number of theories. \n \nThese include endometrioma-induced damage to the ovarian parenchyma, pelvic anatomy distortion due \nto adhesion formation, chronic inflammation in the pelvis and peritoneal fluid linked to superficial and \ndeep peritoneal lesions, any associated adenomyosis, altered hormone and cell -mediated functions in the \nendome trium, dyspareunia (and consequently difficulty having intercourse), and potential iatrogenic \ndamage during ovarian parenchyma surgery (Somigliana et al., 2017; Llarena et al., 2019). Reduced \ntubal function, poor folliculog enesis and/or oocyte quality, and/or changes to the uterine milieu that \nhinder sperm motility and embryo implantation are all possible outcomes of these issues (Somigliana et \nal., 2017; Llarena et al., 2019). \nIn 17 –44% of cases, endometriosis manifests as an ovarian endometrioma. The relationship between \nendometrioma and altered ovarian endocrine function has received special attention in the scientific \nliterature. Massive concentrations of free iron, reactive oxygen species, proteolytic enzymes, and \ninflammatory molecules are found in the fluid of endometriomas. These substances eventually cause \nfibrous tissue to replace normal ovarian cortical tissue, which in turn reduces the pool of primordial \nfollicles (Sanchez et al., 2014; Llarena et al., 2019). Accor ding to a recent systematic review, \nendometriosis considerably lowers anti-Mullerian hormone (AMH) levels as compared to controls. \n \nAdditionally, a subgroup analysis that looked at the antral follicle count (AFC) of ovaries with \nendometriomas discovered th at the affected ovary's AFC was considerably lower than the contralateral \novary's prior to surgery. This confirms that the majority of ovarian reserve loss happens before surgery \n(Tian et al., 2021). Additionally, the ovary may be subjected to mechanical s tress due to large \nendometriomas (Llarena et al., 2019). In comparison to age -matched non -endometriosis controls, \nwomen with endometriomas have lower AMH levels and a faster loss in ovarian reserve (Sanchez et al., \n2014). Furthermore, endometriosis is freq uently associated with a higher risk of premature ovarian \nfailure and less ovulation in the afflicted ovary relative to the normal ovary. \nAlthough these findings are still debatable, it has also been proposed that women with endometriomas \nhave lower-quality oocytes. Women with endometriosis had oocytes with decreased in -vitro fertilization \nand in-vitro maturation rates, according to data from IVF operations (Harb et al., 2013; Sanchez et al., \n2017). To determine whether endometriosis affects embryo quality,  a number of studies have examined \nthe quality of embryos derived from the oocytes of women who have the condition. In a study with 235 \nhuman embryos, scientists discovered that embryos derived from the oocytes of women with \nendometriosis were more likely to exhibit cytoplasmic fragmentation, uneven cleavage, and nuclear and \ncytoplas mic abnormalities than those from patients with other forms of infertility. \nHowever, patients with endometriosis appear to have similar rates of embryo aneuploidy compared to \nunaffected age-matched controls, and those who have undergone IVF for other reasons appear to have \ncomparable rates of pregnancy, live birth, and miscarriage (Gonz -Alez-Comadran et al., 2017). Even \nthough there is strong evidence linking endometriosis to in fertility, only 30 to 50% of endometriosis -\naffected women are infertile, and many of them are able to conceive naturally (Somigliana et al., 2017). \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 3 \n \n \n \n \nThe role of surgery in improving fertility  \nA contentious issue is the surgical management of infertility br ought on by endometriosis. Specifically, \nthere is disagreement on whether surgery or IVF should be used as the initial treatment for these patients \n(Calagna et al., 2020). The decision -making process is complicated because the likelihood of enhancing \nnatural fertility through surgical intervention can depend on a number of variables, including the \npatient's age, preferences, history of previous surgeries, presence of other infertility factors, ovarian \nreserve, estimated endometriosis fertility index (EFI), and the presence and severity of pain symptoms. \nThis staging technique predicts the rates of non -IVF pregnancies following surgical staging and \ntreatment for endometriosis. \n \nThe identification of deep infiltrated endometriosis (DIE) prior to surgery can po tentially be a useful \nindicator of the severity of the procedure. Furthermore, in the context of infertility, DIE is a significant \nfactor in deciding whether to use ARTs or move on with a surgical intervention, especially when paired \nwith predictive tools such as the EFI (Condous et al., 2024). For individuals with endometriosis, the \ninitial indication for surgery is the presence of symptoms that are not adequately controlled with \nmedication (Dunselman et al., 2014).  \n \nIn ASRM stage III and IV endometriosis,  it is less evident whether surgical treatment improves fertility \n(Koch et al., 2012; Dunselman et al., 2014). \n \nThe 3-year projected cumulative pregnancy rate following laparoscopic surgery was 62%, according to a \nprospective cohort study conducted by Adamson and Pasta (1994). According to other research, patients \nwho had surgery to correct DIE prior to IVF operations had higher post -IVF conception rates than \npatients who did not have surgery (Ferrero et al., 2009). According to Liang et al. (2024), surgery , \nwhether total or partial, increased the likelihood of getting pregnant. This emphasizes how important \nsurgical procedures are as a treatment for DIE; even if they don't completely eradicate the condition, \nthey can still have a significant positive impact  on fertility outcomes. Nevertheless, patients should \nalways carefully consider the risks associated with surgery before deciding to have it done. \nHowever, according to some other research, surgery has no effect on fertility outcomes (Vercellini et al., \n2006). In order to restore normal pelvic architecture in women with DIE, laparoscopic intervention may \nbe suggested; nevertheless, the indication should be thoroughly reviewed with the patient (Dunselman et \nal., 2014). For women with DIE who primarily want t o have children, some experts recommend IVF as \nthe first line of treatment instead of surgery (Falcone and Flyckt, 2018). \n \nEffects of surgical methods on fertility preservation and ovarian reserve in the treatment of \nendometriosis The potential benefit of  removing an endometrioma to boost fertility must be weighed \nagainst the possibility of harming the ovarian reserve, which has been discussed by a number of authors \n(Dunselman et al., 2014). \nAMH levels really drop following the removal of an endometrioma, according to numerous studies and \nmeta-analyses (Raffi et al., 2012; Somigliana et al., 2012; Seyhan et al., 2015; Goodman et al., 2016). \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 4 \n \nFurthermore, in the post -operative period, ovarian cystectomy has been linked to a 2.4 –13% risk of \npremature ovarian failure (Busacca et al., 2006). \n \nPrior to therapy, people with bilat eral ovarian cysts, advanced surgical staging, a fully contained \nDouglas pouch, advanced age, elevated BMI, and shorter menstrual cycles all had considerably lower \nAMH levels than people without these problems. \n \nFurthermore, within a year after laparoscopic cystectomy, AMH levels continued to drop (Zhang et al., \n2024). Numerous factors have been suggested as causes of surgery -induced damage to the ovarian \nparenchyma, such as the overremoval of healthy ovarian tissue (Muzii et al., 2002), electrocoagulation -\ninduced vascular damage, and autoimmune reactions brought on by severe local inflammation (Li et al., \n2009). Conservative surgical management of ovarian endometriomas usually includes a num ber of \nalternatives, such as ethanol -based sclerotherapy, ablative procedures (such as laser, plasma energy, or \nbipolar diathermy), and cystectomy by stripping, as well as a combination of these methods. \n \nIn India, endometriosis is very common, particularly in infertile individuals. The purpose of this study \nwas to assess the results of surgical treatment for endometriosis patients in a government tertiary \nhospital with underdeveloped IVF facilities. \n \n2. Methodology  \nStudy Design \nIn order to assess the effects of surgical intervention on uterine receptivity and pregnancy outcomes in \nwomen with endometriosis, this study is planned as an experimental investigation. There will be two \ngroups in the study: \nIntervention Group (Group A):  \nEndometriotic lesions and adhesions are being removed in women undergoing laparoscopic surgery for \nendometriosis.  \n \nGroup B, the control group:  \nwomen undergoing conservative medical treatment, such hormone therapy or painkillers.  \n \nArea of Study  \nThe study will be carried out at several government hospitals in Delhi, guaranteeing access to a range of \npatient demographics and making use of the cutting -edge surgical and diagnostic capabilities offered by \nthese establishments. In order to guarantee that participants receive to p-notch care, these facilities were \nchosen for their proficiency in gynecology and reproductive health. \n \n Sample Size  \nThere will be 150 participants in total, split equally between two groups (75 in Group A and 75 in Group \nB). The sample size was establis hed through statistical power calculations to guarantee sufficient \nrepresentation and validity of the results. \n \n \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 5 \n \nEvery demographic factor, clinical characteristic, sonographic characteristic, and hormonal evaluation \nwas completed. Following that, staging w as carried out based on the results of the laparoscopic and \nultrasonographic procedures as well as the clinical pelvic assessment. A verbal scale that was associated \nwith the visual analog scale (VAS) was used to score pain. where the worst discomfort is r epresented by \n0. However, this was classified as no discomfort, moderate pain, severe pain, and intolerable pain on a \nverbal scale. Patients were chosen for laparoscopic surgery if their ovarian endometrioma measured \nmore than 4 cm by USG. Patients who had  no ovarian endometrioma or whose endometrioma measured \nless than 4 cm were chosen for ovulation induction, whether or not they had previously taken a GnRH \nagonist. Ovarian reserve, tubal patency, male factor, and other related comorbidities were taken int o \nconsideration while planning further infertility treatment. \n \n \n3. Results  \nThrough pelvic assessment and USG evaluation, 150 individuals were chosen. Measurements were made \nof S. FSH, S. TSH, and S. AMH. Surgery was chosen for those with endometriomas larger  than 4 cm. \nThree months after surgery, S. FSH and S. AM H levels were assessed. SPSS v20 .0 was used to analyze \nthe results. \n \nTable1. shows the demographic variables of the study participants.  \nMost of the patients were >30 years and mean age was 29.64 years  & 70.52% had primary infertility. \nDemographic variables (n=150)   \nAge (mean+-)  29.64+-6.22  \nType of inferility  \nPrimary \nSecondary \nDURATION of marriage \n70.52% \n29.48% \n6.54+-3.98 \nPARITY(%) \nNULLIPARA  \nMULTIPARRA  \nBMI \n \n75.64% \n24.36% \n24.76+-3.98  \n  \n \n \nTable1. shows the pain score by verbal scale. \nMost of the patients who had endometrioma was suffering from moderate to severe pain 68% and there \nwas no chronic pelvic pain in 21% patients. \n \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 6 \n \nPain score by verbal scale \n(n=150)  \nNo of patients  Percentage  \nNo pain  32  \n21.33333  \nModerate pain  58  \n38.66667  \nSevere pan  46  \n30.66667  \nUnbearable pain  14  \n9.333333  \n \nFig 1: Clinical Presentation of Patients.  \nDysmenorrhea  (76.24%)was the most important clinical symptom followed by Menorrhagia (54.61%) \nand chronic pelvic (40.51%).  \n \n \n \n \nFig. 2. shows the data on associated pathology of the patients \n76.24\n54.61\n40.51\n8.56 32.82\nDysmenorrhea\nMenorrhagia\nChronic pelvic\nUrinary and bladdder symptoms\nDyspareunia\n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 7 \n \n \n \nFig. 3: Comparison of pain before and after surgery \n \nReduction of pain in patients with chronic pelvic pain and endometrioma  were not significantly \nimproved after surgery. At 95% confidence interval the two -tailed P value equals 1.000 considered to be \nnot statistically significant  \n \nTable 3. shows the data of USG findings. \n62.66% endometrioma were unilateral and 28% were bilateral. \n   \nSize of \ntumour(%)  \n2-4cm  4-6cm  >6cm  No tumour   \n9.46 4.22 2.68 4.82 3.22 2.57\n72.86\n0\n10\n20\n30\n40\n50\n60\n70\n80\nassociated pathology\n23%\n32% 34%\n44%\n27% 26%\n0%\n5%\n10%\n15%\n20%\n25%\n30%\n35%\n40%\n45%\n50%\nno pain moderate\npain\nsevere pain\nbefore operation\nafter operation\n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 8 \n \nlaterality  18.36% \nUnilateral \n94 \n62.66% \n51.24% \nBilateral \n42 \n28%  \n24.48% \nNo tumour  \n14 \n9.33%  \n3.82%  100%  \nAdhesion \nwith  \nSuperficial \n90 \n60% \nDeep \n42 \n28%  \nPouch of \ndouglass \nobliteration \n8 \n5.33%  \nNo tumor \n10 \n6.66%  \nsurroundings  \n \nTable 4. shows the data on baseline hormone levels. \nThe mean serum AMH level was 2.72±1.23, FSH was 5.49±1.76, TSH was 3.52±1.49 and prolactin was \n18.29±6.57, respectively.  \n \nHormone levels  Mean+-SD  \nAMH(ng/ml)  2.72±1.23  \nFSH(IU/ml)  5.49±1.76  \nTSH(mIU/l)  3.52±1.49  \nProlactin(ng/ml)  18.29±6.57  \n \nTable  5. fertility management without surgery  \n \nFertility management without surgery  n=75  Percentage  \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 9 \n \nGnRHa Gonadotrophins  \nGnRHa, Gonadotrophins & IUI \nOID \nOID & Gonadotrophins  \nOID, Gonadotrophins & IUI \nPlanned for IVF  \n9 \n14 \n12 \n13 \n2 \n25 \n12% \n18.66% \n16% \n17.33% \n2.66% \n33.33%  \n \nTable  6. fertility management without surgery  \n \nTypes of surgery  N=75  percentage  \nCoagulation and adhesiolysis  \nExciscion of endometrioma  \nAspiration of cyst \nlapraomy  \n41 \n19 \n5 \n10 \n54.66% \n25.33% \n3.33% \n6.66%  \n \n \nTable 7. show outcome of fertility treatment. \nOnly 5.33% patients were successful with live birth and pregnancy positive were 20%  of patients bit \nwith complicated msdicarriage. \nOutcome of fertility treatment  N=150  percentage  \nPregnancy positive \nTake home baby \nContinuing management \nWaiting for IVF \nDrop out due to various reasons \n30 \n8 \n46 \n24 \n42  \n20% \n5.33% \n30.66% \n16% \n28% \n \n \n \n \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 10 \n \n \n4. Discussion  \nFunctional endometrial glands and stroma in ectopic sites such as the pelvic peritoneum, ovaries, recto -\ncervical septum, or pouch of Douglas are characteristics of endometriosis. Endometriosis affects 6 –10% \nof women in their reproductive years. About 25 –50% of women who are infertile may have \nendometriosis. The average age at diagnosis is between 25 and 35. Undiagnosed endometriosis may be \npresent in 50 –60% of women who experience persistent pelvic pain or infertility  (Giudice IC., 2010 ). \nWomen with obstruc tive Müllerian abnormalities are more likely to have it  (Burney RO, Giudice IC., \n2012). The disease's potential causes include direct transplantation, lymphatic vascular spread, coelomic \nmetaplasia, retrograde menstruation, weakened immunity, and, most rec ently, a genetic foundation  \n(Moridi I et al.,  2017 ).  According to recent data, stem cells produced from bone marrow move to the \nectopic and utopic endometrium and develop into endometrial cells. CXCR4 and CXCL -12 are \nimportant. They promote tissue develo pment, angiogenesis, and the recruitment of stem cells  (Moridi I \net al.,  2017 ). In addition to stimulating the growth of the ectopic endometrium, activated macrophages \nat the site release IL-1, IL-6, IL-8, TNF, Rantes, and VEGF. \nFirst-degree relatives of affected women are 6 –8 times more likely to have endometriosis  (Bruner-Tran \nKI, et al., 2013 ).  Endometriosis is exacerbated by changes in estrogen metabolism and synthesis. \nChronic inflammation caused by excessive prostaglandin, metalloproteinase, and che mokine production \ndisrupts ovarian, tubal, or endometrial function and leads to disrupted folliculogenesis and implantation \nfailure. Infertility affects 30 to 50% of women with endometriosis. Compared to women without \nendometriosis, women with minimal and mild endometriosis who receive gonadotropin and IUI had \nreduced monthly fecundity. The ovarian reserve is adversely affected by endometrioma. \nThe ovarian reserve is also reduced by surgical treatment. In order to provide therapeutic guidelines, \nmany classification and staging systems have been created. Although it has several drawbacks, the most \nwidely used classification system for managing fertility is the most recent iteration of the American \nSociety of Reproductive Medicine's (ASRM) updated classificati on system, which is based on surgical \nfindings at laparoscopy or laparotomy  (Guzick DS, et al., 2005 ). In order to comprehend deeply \ninfiltrating lesions, the Enzian classification was created in 2005. A new staging method, known as the \nendometriosis fertility index (EFI), which combines the parameters that best predict conception without \nIVF, was proposed in 2009 following an analysis of the surgical and clinical outcomes of 697 patients  \n(Adamson GD, Pasta DJ. 2010 ). The European Society of Human Reproduct ion and Embryology \n(ESHRE) 2021 -GDG (Guideline Group) suggests that infertile patients with endometriosis should \nreceive fertility treatment before deciding to have surgery.  This should be determined by the following \nfactors: tumor size (>4 cm), presence o r lack of pain complaints, patient age and preference, prior \nsurgical history, other causes of infertility, Ovarian reserve as well as EFI score estimate of 10.  \nThe present study included 150 patients from different backgrounds. Most of the patients were >30 years \nand mean age was 29.64 years  &  70.52% had primary infertility. Surgery was the primary treatment for \n50% of patients in this series, which is much higher than in other comparable studies. However, a study \nconducted by a collaborative group in Canada that examined 341 infertile women with mild to minor \nendometriosis using laparoscopy revealed that the treatm ent group had a considerably higher pregnancy \nrate (30.7% vs. 17.7%, p=0.006), indicating that surgical therapy improved fecundity. 11. Since our \nfacility is a government -run tertiary care facility, the majority of the patients arrived from all over the \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 11 \n \nnation at an advanced stage of their illness, exhibiting severe symptoms, a huge endometrioma, or a \nsevere adhesion. \nTherefore, these people need surgery to regulate their fertility as well as to relieve their symptoms. The \nmean serum AMH level was 2.72±1.23, FSH was 5.49±1.76, TSH was 3.52±1.49 and prolactin was \n18.29±6.57, respectively.  \n It's unclear if surgery raises serum FSH or lowers serum AMH. if surgery should be postponed as long \nas feasible. For patients with a  healthy ovarian reserve, letrozole or clomiphene citrate was used to \ninduce ovulation for at least six cycles. If OID did not respond, gonadotropin was then added for three \nadditional cycles.  GnRH agonist was utilized prior to ovulation induction for one to three cycles in \ncertain patients with endometrioma <4 cm. 16% of  patients had IUI. Therefore, every stage of fertility \nmanagement in our study was hindered. Three recurring endometrioma patients with extremely low \nAMH were included. They are awaiting e mbryo transfer and have their embryos cryopreserved. \nTherefore, the outcome cannot be presumed. Nonetheless, we have made every effort to provide these \nindividuals with the finest care possible. \n \nEndometriosis-related discomfort, infertility, or both are t he two main issues that women with \nendometriosis face. ESHRE 202110 Recommendations for hormone treatment state that ovarian \nsuppression therapy should not be recommended to increase fertility in endometriosis -affected infertile \nwomen. In order to increase  future pregnancy rates, postoperative hormone suppression with a GnRh \nanalogue should not be recommended to women who are trying to conceive. \n \nHormonal therapy should be made available to women who are unable or choose not to become pregnant \nright after s urgery because it does not impair fertility and enhances the immediate results of pain \nmanagement surgery. 10. According to ESHRE10 recommendations, since it increases the likelihood of \ncontinuing pregnancy, surgical laparoscopy may be recommended as a tre atment option for \nendometriosis-associated infertility in rASRM stage I/II endometriosis. Despite the lack of comparison \nstudy data, clinicians may think about using operational laparoscopy to treat endometrioma -associated \ninfertility because it may improv e the patient's chances of a spontaneous conception. 10. Operative \nlaparoscopy for deep infiltrating endometriosis may be a therapy option for symptomatic people who \nwish to become pregnant, even if there is no strong evidence that it increases fertility. \n \n5. Conclusion  \n \nIn addition to being linked to a reduced ovarian reserve, endometriosis is also the cause of a decreased \novarian stimulation response. Therefore, obtaining effective reproductive treatment for this patient \npopulation is quite difficult. We int end to overcome our treatment challenges and get the best outcome \nby increasing awareness, detecting patients early, enhancing surgical procedures, and maximizing ART \nfacilities. \n \nReferences \n1. Macer ML, Taylor HS. Endometriosis and infertility: review of the pathogenesis and treatment of \nendometriosis associated infertility. Obstet Gynecol Clin North Am; 39:535-49. 2012 \n2. Giudice IC. Clinical Practice. Endometriosis, N England J Med 362(25):2389. 2010.  \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 12 \n \n3. Olive DI, Henderson DY. Endometriosis and Müllerian Anomalies. Obstet Gynecol 69:412. 1987.  \n \n4. Burney RO, Giudice IC. Pathogenesis and Pathophysiology of Endometriosis. Fertil Steril 98(3):511. \n2012. \n5. Moridi I, Mamillapalli R, Cosar E et al. 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Risk factors associated with \nchanges in serum anti-Mullerian € hormone levels before and after laparoscopic cystectomy for \nendometrioma. Front Endocrinol (Lausanne) 2024;15:1359649 \n33. Muzii L, Bianchi A, Croce  C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: is the \nstripping technique a tissue-sparing procedure? Fertil Steril 2002;77:609–614. \n34. Li CZ, Liu B, Wen ZQ, Sun Q. The impact of electrocoagulation on ovarian reserve after \nlaparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients. Fertil Steril 2009; \n92:1428–1435. \n \n \n \n \n \n \n\n \nInternational Journal on Science and Technology (IJSAT) \nE-ISSN: 2229-7677   ●   Website: www.ijsat.org   ●   Email: editor@ijsat.org \n \nIJSAT25025664 Volume 16, Issue 2, April-June 2025 14","source_license":"CC0","license_restricted":false}