Endometriosis and infertility: pathophysiology, treatment strategies, and reproductive outcomes

Shai E Elizur, Jazayeri Shoushtari Seyed Mostafa, Jollanar Mostafa, Elad Berkowitz, Raoul Orvieto
Archives of gynecology and obstetrics · 2025 · vol. 312(4) , pp. 1037–1048 · doi:10.1007/s00404-025-08124-1 · PMID:40689964 · W4412525743
review OA: gold CC0 ⤵ 13 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review examines endometriosis's pathophysiology, its impact on infertility, and treatment strategies including hormonal therapy, surgery, and assisted reproductive technologies, proposing a personalized approach to optimize outcomes.

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

This 2025 review paper examines how endometriosis contributes to infertility by synthesizing evidence on classification systems, the mechanisms linking disease to impaired conception (including anatomical disruption, pain/dyspareunia, peritoneal inflammation, immune dysregulation, and ovarian reserve effects), and how these factors influence both natural conception and assisted reproductive technologies (IUI/IVF). It highlights the Endometriosis Fertility Index (EFI) as a predictor of post-surgical spontaneous pregnancy and notes that it can be estimated preoperatively with imaging and clinical data, while emphasizing a major limitation that most EFI components are not direct measures of anatomic disease staging. For ovarian endometriomas specifically, the review reports meta-analytic evidence of reduced antral follicle count and AMH (with possible oxidative/toxic effects and “burn-out” mechanisms), while acknowledging that findings on impaired ovulation are mixed and sometimes inconclusive. This paper is centrally about endometriosis — specifically endometriosis-related infertility, including pathophysiology, treatment strategies, and reproductive outcomes.

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Abstract

Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial-like tissue, leading to pain, dysmenorrhea, and infertility. This review explores classification systems, the mechanisms of endometriosis-related infertility, and the impact of endometriosis subtypes on fertility outcomes. Medical therapies, such as hormonal suppression, alleviate symptoms but are unsuitable for women who wish to conceive. Surgery may enhance natural conception rates in select cases but may have a negative impact on ovarian reserve. Assisted reproductive technologies, such as intrauterine insemination and in vitro fertilization, provide effective fertility treatments. However, endometriosis can negatively affect oocyte quality and implantation rates.Given the complexity of endometriosis and its varying impact on fertility, a personalized, multidisciplinary approach is recommended. This review proposes an updated treatment algorithm that integrates clinical, imaging, and other infertility causes to optimize treatment outcomes. Future research is needed for refining classification systems and indications for fertility-preservation treatments, as well as improving assisted reproductive technology success rates.

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Outcome instruments

MUSA rASRM Enzian

Condition tags

mesh:D004715endometriosisdysmenorrheainfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

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References (68)

Cited by (13)

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