OPTIMIZATION OF MANAGEMENT STRATEGIES FOR ENDOMETRIOSIS-ASSOCIATED INFERTILITY IN PATIENTS WITH DIMINISHED OVARIAN RESERVE

The relevance of the study is determined by the high prevalence of endometriosis among women of reproductive age and its significant negative impact on fertility.The purpose of the study is to substantiate approaches to optimizing the clinical management strategy for patients with endometriosis-associated infertility and diminished ovarian reserve based on the analysis of the clinical and pathogenetic features of this condition and the current possibilities of assisted reproductive technologies.Methods of analysis, systematization, and generalization of contemporary scientific sources were applied. Comparative analysis of clinical research findings and analytical interpretation of data concerning the influence of endometriosis on ovarian reserve indicators and the effectiveness of assisted reproductive technologies were performed. Structural and functional analysis of clinical factors determining reproductive prognosis in patients with endometriosis was also conducted.Results. The main pathogenetic mechanisms of infertility formation in endometriosis and their impact on ovarian reserve were investigated. It was established that chronic inflammatory processes, hormonal dysregulation, oxidative stress, and structural ovarian changes contribute to a decrease in the number of antral follicles and a reduction in anti-Müllerian hormone levels. It was demonstrated that patients with endometriosis and diminished ovarian reserve show a reduced ovarian response to stimulation and lower effectiveness of assisted reproductive technology programs. It was also revealed that surgical treatment of endometriomas may lead to additional decline in ovarian reserve, which complicates the selection of optimal clinical management strategies.Conclusions. The results obtained made it possible to substantiate the feasibility of an individualized approach to the management of patients with endometriosis-associated infertility and diminished ovarian reserve. It was demonstrated that improving treatment effectiveness requires early assessment of ovarian reserve indicators, limitation of unjustified surgical interventions on the ovaries, and timely use of assisted reproductive technologies. The proposed approaches contribute to more rational utilization of reproductive potential and increase the probability of achieving pregnancy in this group of patients.