OVARIAN ENDOMETRIOMA AND REPRODUCTIVE FUNCTION: A REVIEW OF PATHOGENETIC, SURGICAL, AND EMBRYOLOGICAL ASPECTS

OVARIAN ENDOMETRIOMA AND REPRODUCTIVE FUNCTION: A REVIEW OF PATHOGENETIC, SURGICAL, AND EMBRYOLOGICAL ASPECTS DOI: https://doi.org/10.31393/reports-vnmedical-2026-30(2)-29Keywords: endometrioma, ovarian reserve, anti-Müllerian hormone (AMH), assisted reproductive technologies (ART), transvaginal oocyte retrieval, oocyte quality, embryogenesisAbstract Ovarian endometrioma remains one of the most challenging pathologies in reproductive medicine, directly compromising female fertility and creating significant hurdles at all stages of assisted reproductive technology (ART) programs. Objective – to systematize and analyze current scientific data regarding the complex pathogenetic and surgical impact of endometriomas on ovarian reserve, to evaluate the quality of gametes and embryogenesis, and to determine the specific risks of transvaginal oocyte retrieval (TVOR) in patients with this pathology. An analysis of recent specialized publications, systematic reviews, and meta-analyses in international databases (PubMed, Scopus, Google Scholar) was conducted. Endometrioma was found to deplete ovarian reserve via chronic inflammation and oxidative stress, thereby reducing anti-Müllerian hormone (AMH) levels. Surgical excision of the cyst leads to a further irreversible decline in AMH by an average of 39.5% for unilateral and 57.0% for bilateral procedures. A diagnostic dissociation was identified in the early postoperative period: AMH drops immediately, while the antral follicle count Берлінська Л. І. (AFC) on ultrasound temporarily remains stable. The toxic microenvironment of the cyst impairs oocyte quality and early cleavage rates; however, embryos that reach the blastocyst stage demonstrate high implantational potential due to natural selection. Performing TVOR in the presence of cysts carries a risk of cyst transfixion (14%) and follicular fluid contamination (16%), but with proper antibiotic prophylaxis, these risks remain manageable. So management of patients with endometriomas in ART programs requires a personalized approach, prioritization of organ-preserving surgical techniques, and mandatory AMH assessment prior to any intervention to optimize the reproductive prognosis. Downloads References [1] Akgul, O. K., Guraslan, H., Kovalak, E. E., Karacan, T., Aydin, T. O., & Cay, T. (2022). Association of endometrioma size with serum anti-Mullerian hormone. Journal of the College of Physicians and Surgeons Pakistan, 32(9), 1132- 1136. doi: 10.29271/jcpsp.2022.09.1132 [2] Alborzi, S., Sorouri, Z. Z., Askary, E., Sonboleh, Z., Alavi, S., Poordast, T., & Abadi, A. K. H. (2026). Investigating unilateral ovarian endometrioma’s effect on ova and embryo quality in 409 infertile endometriotic patients. 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Frontiers in Endocrinology, (15), 1397279. doi: 10.3389/fendo.2024.1397279 challenging pathologies in reproductive medicine, directly compromisof assisted reproductive technology (ART) programs. Objective – to the complex pathogenetic and surgical impact of endometriomas on and to determine the specific risks of transvaginal oocyte of recent specialized publications, systematic reviews, and meta-anal- Scholar) was conducted. Endometrioma was found to deplete ovarian reducing anti-Müllerian hormone (AMH) levels. Surgical excision an average of 39.5% for unilateral and 57.0% for bilateral procedures. period: AMH drops immediately, while the antral follicle count 2026, Т. 30, №2 (AFC) on ultrasound temporarily remains stable. The toxic microenvironment age rates; however, embryos that reach the blastocyst stage demonstrate Performing TVOR in the presence of cysts carries a risk of cyst transfixion proper antibiotic prophylaxis, these risks remain manageable. So requires a personalized approach, prioritization of organ-preserving to any intervention to optimize the reproductive prognosis. Downloads Published How to Cite Issue Section License Copyright (c) 2026 Berlinska L. I. This work is licensed under a Creative Commons Attribution 4.0 International License.