Individualized fertility preservation counselling for women with endometriosis-a systematic review

Summary Endometriosis is a chronic disease that may require surgical intervention under certain circumstances. Although the condition itself is associated with impaired fertility in 30–50% of affected individuals, surgical treatment may further reduce ovarian reserve and thereby additionally compromise fertility. As fertility preservation (FP) is increasingly being considered in this context, a clear understanding of how ovarian surgery affects the remaining follicle reserve and the outcome of oocyte cryopreservation is essential to guide counselling on the appropriate timing. The purpose of this study is to summarize the available evidence on the impact of ovarian surgery on oocyte retrieval outcomes in the context of FP and to propose a counselling framework based on these findings. The search of electronic databases identified seven observational studies on this topic. In terms of oocyte cryopreservation outcomes, the included studies consistently reported a decrease in the total number of oocytes retrieved in cases of previous surgery for endometriosis. Reported mean or median oocyte numbers ranged approximately from 8 to 14 per cycle in non-operated patients, with significantly lower yields in previously operated women ranging from about 4.5 to 7 oocytes per cycle. Existing evidence suggests that previous ovarian surgery for endometriosis negatively affects oocyte yield for FP, but long-term reproductive outcomes remain insufficiently characterized. Such data would be required to enable a more accurate assessment of FP effectiveness. The available evidence indicates that FP counselling should be individualized, with particular emphasis on women with diminished ovarian reserve, age >35 years, or planned bilateral or repeated ovarian surgery. Zusammenfassung Endometriose ist eine chronische Erkrankung, die unter bestimmten Umständen einen chirurgischen Eingriff erfordern kann. Obwohl die Erkrankung selbst bei 30–50 % der Betroffenen mit einer eingeschränkten Fruchtbarkeit verbunden ist, kann die operative Therapie die ovarielle Reserve weiter verringern und damit die Fertilität zusätzlich beeinträchtigen. Da Maßnahmen zur Fertilitätsprotektion (FP) in diesem Zusammenhang zunehmend in Betracht gezogen werden, ist ein klares Verständnis darüber erforderlich, wie sich operative Eingriffe am Ovar auf die verbleibende Follikelreserve und das Outcome der FP auswirken. Ziel dieser Studie war es daher, die verfügbaren Daten zum Einfluss von ovariellen Operationen auf die Eizellentnahme im Rahmen der FP zusammenzufassen und auf dieser Grundlage einen Beratungsrahmen vorzuschlagen. Die Recherche in elektronischen Datenbanken identifizierte sieben Beobachtungsstudien zu diesem Thema. Die eingeschlossenen Studien berichteten übereinstimmend von einer verminderten Gesamtzahl gewonnener Eizellen bei Patientinnen mit vorangegangener Operation wegen Endometriose. Die berichteten mittleren oder medianen Eizellzahlen lagen bei nicht operierten Frauen bei etwa 8 bis 14 pro Zyklus, während zuvor operierte Frauen signifikant niedrigere Ausbeuten von etwa 4,5 bis 7 Eizellen pro Zyklus aufwiesen. Die derzeitige Evidenz legt nahe, dass frühere ovarielle Eingriffe bei Endometriose die Oozytenzahl im Rahmen einer FP negativ beeinflussen. Langfristige reproduktive Ergebnisse sind bisher unzureichend untersucht, wären jedoch erforderlich, um die Wirksamkeit der FP präziser beurteilen zu können. Eine Beratung zur FP sollte individualisiert erfolgen, wobei Frauen mit verminderter ovarieller Reserve, einem Alter über 35 Jahren oder geplanter bilateraler bzw. wiederholter Ovarialchirurgie mit besonderer Priorität beraten werden sollten. 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Author information Authors and Affiliations Contributions All authors have substantial contributions to the conception, design and article preparation. All authors have critically revised and approved this final article version and agree to be accountable for all aspects of this work. Corresponding author Ethics declarations Conflict of interest J. Téoule, K. Bundschu and K. Hancke declare that they have no competing interests. Ethical standards All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Téoule, J., Bundschu, K. & Hancke, K. Individualized fertility preservation counselling for women with endometriosis—a systematic review. Wien Med Wochenschr (2026). https://doi.org/10.1007/s10354-026-01151-w Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s10354-026-01151-w