MORPHOLOGICAL FEATURES OF OVARIAN ENDOMETRIOSIS: CHANGES IN OVARIAN TISSUE AND THEIR SIGNIFICANCE FOR REPRODUCTIVE FUNCTION

A. A. Grigoryants, Kristina Alexandrovna Makarova, Markha Shakhidovna Musayeva, Mata Aslanbekovna Baysaeva, Aida Jamaluttinovna Bagova
In: V.F.Snegirev Archives of Obstetrics and Gynecology · 2026 · doi:10.17816/aog701761 · W7160967079
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Ovarian endometriosis involves chronic inflammation, fibrosis, and follicular damage, negatively impacting ovarian reserve and reproductive function, necessitating a comprehensive morphological and clinical assessment for prognosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This review examines current evidence on how ovarian endometriomas form and how they remodel ovarian tissue—focusing on morphogenesis of endometrioid cysts, histoarchitectural changes in the cyst wall and adjacent cortex, and downstream effects on folliculogenesis and ovarian reserve, using data drawn from clinical-pathologic and molecular studies. It reports that endometriomas can arise via multiple pathways (e.g., involving functional/lutein cyst transformation or invagination of surface endometriosis during cyclic bleeding), and that chronic hemorrhage, inflammation, fibrosis, microcirculatory damage, and injury to primordial follicles and granulosa/oocyte-related cells contribute to reduced reproductive potential; a key limitation the authors note is that the relationship between specific morphologic phenotypes and the degree of fertility impairment remains insufficiently systematized. It also discusses that vascular remodeling and progressive loss of normal ovarian tissue differentiation are prominent features, with additional variability by age (e.g., in adolescents). This paper is centrally about endometriosis — specifically ovarian endometriosis/endometriomas and the morphological mechanisms linking tissue alterations to reproductive dysfunction.

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Abstract

Ovarian endometriosis is one of the most clinically significant forms of endometriosis, as it is accompanied by pronounced morphological changes in ovarian tissue and is often associated with impaired reproductive function. The formation of endometrioid cysts is accompanied by chronic inflammation, fibrosis, impaired microcirculation and damage to the follicular apparatus, which creates unfavorable conditions for the preservation of ovarian reserve. Traditional clinical and instrumental assessment methods do not always allow us to fully reflect the depth of structural changes in ovarian tissue and their impact on fertility. In recent years, special attention has been paid to the morphological and molecular aspects of ovarian endometriosis, which provide a new perspective on the mechanisms of reproductive potential decline and variability in clinical outcomes. This review article summarizes current data on the morphogenesis of endometrioid cysts, histoarchitectonics of the affected and adjacent ovarian tissue, the role of inflammation and fibrosis, as well as changes in the follicular apparatus and ovarian reserve. The morphological prerequisites for infertility and a decrease in the effectiveness of assisted reproductive technologies, including the impact of surgical treatment, are analyzed. The presented data emphasize the need for a comprehensive morphological and clinical approach to assessing the reproductive prognosis in patients with ovarian endometriosis and substantiate the prospects for further research in this area.

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endometriosisinfertility

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