Prognostic role of immunohormonal and ultrasound markers in the restoration of reproductive function in women with endometriosis after treatment

The objective: to evaluate the prognostic value of immunological, hormonal, and ultrasound markers in the restoration of reproductive function in women with endometriosis after treatment, considering the realization of fertility in natural cycles and through assisted reproductive technologies (ART).Materials and methods. A prospective comparative study was conducted involving 120 women of reproductive age with infertility and laparoscopically and histologically confirmed endometriosis. Patients were randomized into three groups depending on the treatment strategy: laparoscopic ablation/excision with subsequent dienogest therapy (n = 40); laparoscopic resection of endometriomas with inclusion in ART programs and platelet-rich plasma (PRP) support (n = 40); preoperative gonadotropin-releasing hormone (GnRH) antagonist therapy followed by laparotomy (n = 40). The following parameters were assessed: anti-Müllerian hormone (AMH), cancer antigen 125 (CA-125), antral follicle count (AFC), pain intensity using the visual analog scale (VAS), pregnancy rates, and recurrence rates during a 12-month follow-up period.Results. The most favorable prognostic profile for fertility restoration was observed in patients with preserved ovarian reserve (AMH ≥ 2.3 ng/mL, AFC ≥ 7), low CA-125 levels (≤55 U/mL), and minimal pain (VAS ≤ 3). The highest pregnancy rate within one year was achieved in the laparoscopic + dienogest group (62.5%), followed by the laparoscopic + ART group (55.0%) and the GnRH antagonist + laparotomy group (37.5%).Conclusions.Comprehensive assessment of immunological, hormonal, and ultrasound markers provides an opportunity to create an individualized fertility prognosis and optimize treatment strategies for women with endometriosis.Keywords: endometriosis, ovarian reserve, anti-Müllerian hormone, CA-125, antral follicle count, VAS, fertility, assisted reproductive technologies