The Impact of Endometriosis on Ovarian Reserve: A Systematic Review

Ni Luh Lany Christina,1 Dian Tjahyadi,1 Ruswana Anwar,1 Anita Rachmawati,1 Muhammad Allam Rafi2 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 2Department of Medicine, Faculty of Medicine, University of Indonesia, Depok, West Java, IndonesiaCorrespondence: Ni Luh Lany Christina, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Pasteur No. 38 Street, Pasteur, Bandung, West Java, 40161, Indonesia, Tel +6281353455466, Email [email protected]: Endometriosis is a chronic inflammatory condition, causing severe pelvic pain, organ dysfunction, infertility, and mental health issues. Ovarian reserve, indicating the quantity and quality of a woman’s oocytes, is negatively affected by endometriosis, especially in cases with ovarian endometriomas.Purpose: This comprehensive narrative review aims to synthesize and critically evaluate the current evidence on the impact of endometriosis on ovarian reserve.Methods: A systematic literature search was conducted across several databases, including PubMed, Semantic Scholar, ProQuest, Scopus, and Springer. The inclusion criteria encompassed studies published in English between 2015 and 2024. The review process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Studies were critically appraised for quality using Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias Tool (RoB 2.0) for randomized trials.Results: A total of 10 studies were included in this systematic review. The evidence shows that endometriosis significantly reduces ovarian reserve in women, as indicated by lower Anti-Müllerian Hormone (AMH) levels and Antral Follicle Count (AFC) compared to healthy individuals. The condition is linked to chronic pelvic inflammation due to local pro-inflammatory cytokines disrupting ovarian function and oxidative stress from reactive oxygen species damaging oocytes. While surgical interventions like cystectomy help manage symptoms and may enhance fertility, they also risk further reducing ovarian reserve by removing healthy ovarian tissue.Conclusion: This review underscores the importance of early diagnosis and personalized management strategies to preserve ovarian function and fertility. Future research should focus on developing effective treatment strategies that consider immune and hormonal influences, exploring new methods to protect and regenerate ovarian reserve in affected women, and analyzing subtypes along with the impact of clinical versus surgical diagnosis of endometriosis.Keywords: endometriosis, ovarian reserve, endometrioma, infertility