CLINICAL CHARACTERISTICS OF WOMEN WITH ENDOMETRIOSIS-ASSOCIATED INFERTILITY
DOI:
https://doi.org/10.11603/24116-4944.2026.1.15884Keywords:
endometriosis, ovarian endometrioma, endometriosis-associated infertility, ovarian reserve, antral follicle count, laparoscopic surgeryAbstract
The aim of the study – to evaluate the clinical and anamnestic features of patients with endometriosis-associated infertility.
Materials and Methods. The study was conducted at the Scientific and Clinical Center for Endometriosis (Level III accreditation by the European Endometriosis League) of the Multidisciplinary Medical Center of Odesa National Medical University during 2023–2024. A total of 95 infertile women of reproductive age with endoscopically verified genital endometriosis (GE) were examined.
Results and Discussion. The mean age of the patients was (31.5±3.0) years. Primary infertility was diagnosed in 61 (64.71 %) women, and secondary infertility in 34 (35.29 %). The duration of infertility in some cases reached up to 8 years, with an average duration of (4.57±1.32) years. In every second patient, the infertility period ranged from 3 to 5 years – 54 (57.35 %).In patients with infertility lasting less than 3 years, the number of antral follicles (right ovary – 8.8±0.50; left ovary – 7.2±0.40) and the M-echo thickness (9.6±1.2) corresponded to preserved ovarian function. The most pronounced impairments were observed in women with infertility lasting more than 5 years, which was accompanied by an almost twofold reduction in the number of antral follicles (3.9±0.36 and 3.1±0.30) and a decrease in M-echo thickness (7.6±1.5) (p<0.001).In the group of women with infertility duration of less than 3 years, patients with stage I–II endometriosis according to the revised American Society for Reproductive Medicine (r-ASRM) classification predominated (40.00 and 25.00 %, respectively). The most unfavorable course of the disease was observed in patients with infertility lasting more than 5 years, among whom bilateral endometriomas (47.62 %) and severe forms of pelvic adhesive disease (28.57 and 42.86 %, respectively) were predominant. Analysis of ovarian endometriotic involvement revealed that in all groups with infertility duration of less than 3 years, unilateral endometriomas predominated (81.82 %); however, with infertility lasting more than 5 years, bilateral ovarian involvement was more frequently diagnosed (up to 16.37 %). Adhesive processes of the pelvic organs of grade I–II (18.52 and 14.81 %) were more common in patients with shorter infertility duration, while grade III–IV adhesions (9.26 %) were more frequently diagnosed in those with infertility exceeding 5 years.
Conclusions. An increase in the duration of infertility (more than 5 years) can be considered one of the prognostically unfavorable criteria when assessing the reproductive potential of women with endometriosis-associated infertility.
References
1. Moradi, Y., Shams-Beyranvand, M., Khateri, S., Gharahjeh, S., Tehrani, S., Varse, F., Tiyuri, A., & Najmi, Z. (2021). A systematic review on the prevalence of endometriosis in women. Indian Journal of Medical Research, 154(3), 446–454.
https://doi.org/10.4103/ijmr.IJMR_817_18
2. Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A. W., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., Zondervan, K. T., Vermeulen, N., & ESHRE Endometriosis Guideline Group. (2022). ESHRE guideline: Endometriosis. Human Reproduction Open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009
3. Keckstein, J., Becker, C. M., Canis, M., et al. (2020). Working group of ESGE, ESHRE and WES recommendations for the surgical treatment of endometriosis. Part 2: Deep endometriosis. Human Reproduction Open, 2020(1), hoaa002. https://doi.org/10.1093/hropen/hoaa002
4. Zaporozhan, V. M., Hladchuk, I. Z., Rozhkovska, N. M., Marichereda, V. H., & Kozhakov, V. L. (2020). Standardization of laparoscopic treatment of patients with deep infiltrative endometriosis. Collection of the Association of Obstetricians and Gynecologists of Ukraine, 1(45), 22–27. https://doi.org/10.35278/2664-0767.1(45).2020.212157
5. Skorupskaite, K., & Bhandari, H. M. (2024). Endometriosis and fertility. Obstetrics, Gynaecology and Reproductive Medicine, 34(12), 319–325. https://doi.org/10.1016/j.ogrm.2024.08.006
6. Maggiore, U. L. R., Chiappa, V., Ceccaroni, M., Roviglione, G., Savelli, L., Ferrero, S., & Raspagliesi, F. (2024). Epidemiology of infertility in women with endometriosis. Best Practice & Research: Clinical Obstetrics & Gynaecology, 83, 102454. https://doi.org/10.1016/j.bpobgyn.2023.102454
7. Yang, S., Wang, H., Li, D., & Li, M. (2024). An estrogen-NK cells regulatory axis in endometriosis, related infertility, and miscarriage. International Journal of Molecular Sciences, 25(6), 3362. https://doi.org/10.3390/ijms25063362
8. Tang, Hs.-Ch., Lin, T.-Ch., Wu, M.-Hs., & Tsai, Sh.-J. (2024). Progesterone resistance in endometriosis: A pathophysiological perspective and potential treatment alternatives. Reproductive Medicine and Biology, 23(1), e12588. https://doi.org/10.1002/rmb2.12588
9. Pirtea, P., de Ziegler, D., & Ayoubi, J. M. (2023). Endometrial receptivity in adenomyosis and/or endometriosis. Fertility and Sterility, 119(5), 741–745. https://doi.org/10.1016/j.fertnstert.2023.03.004
10. Zaporozhan, V. M., Hladchuk, I. Z., Rozhkovska, N. M., & Haydarzhi, Kh. D. (2022). Deep endometriosis: Review of current recommendations and own data. Collection of Scientific Papers of the Association of Obstetricians and Gynecologists of Ukraine, 2(50), 26–36. https://doi.org/10.35278/2664-0767.2(50).2023.274979
11. Koninckx, P. R., Ussia, A., Adamyan, L., Wattiez, A., & Donnez, J. (2021). Deep endometriosis: Definition, diagnosis, and treatment. Fertility and Sterility, 115(3), 559–571. https://doi.org/10.1016/j.fertnstert.2020.12.024
12. Sanchez, A. M., Vanni, V. S., Bartiromo, L., Papaleo, E., Zilberberg, E., Candiani, M., & Viganò, P. (2020). Is ovarian reserve diminished in women with ovarian endometriomas? Reproductive BioMedicine Online, 41(3), 439–448. https://doi.org/10.1016/j.rbmo.2020.05.012
13. Younis, J. S., Shapso, N., Fleming, R., Ben-Shlomo, I., & Izhaki, I. (2022). Impact of unilateral versus bilateral ovarian endometriomas on ovarian reserve. Human Reproduction, 37(3), 487–496. https://doi.org/10.1093/humrep/deab265
14. Muzii, L., Di Tucci, C., Di Feliciantonio, M., Marchetti, C., Perniola, G., & Panici, P. B. (2021). Antimüllerian hormone is reduced after ovarian endometrioma excision: A systematic review and meta-analysis. Fertility and Sterility, 116(2), 457–467. https://doi.org/10.1016/j.fertnstert.2021.03.037
15. Younis, J. S., Shapso, N., Izhaki, I., & Ben-Shlomo, I. (2023). Ovarian reserve after surgical treatment of endometriomas: A systematic review and meta-analysis. Human Reproduction Update, 29(4), 389–406. https://doi.org/10.1093/humupd/dmad006
16. Hladchuk, I. Z., Rozhkovska, N. M., Sytnikova, V. O., Shpak, I. V., & Syvyi, S. M. (2022). Features of the clinical course and pathomorphological characteristics of ovarian endometriosis and adenomyosis in women of reproductive age. Reproductive Endocrinology, 3(64), 87–92. https://hdl.handle.net/11300/24466
17. Najdi, N., Vakilian, K., Almasi-Hashiani, A., Mirzaie, F., Shokrpoor, M., & Karimi, H. (2024). Anxiety in women with endometriosis: A cross-sectional study. The Open Public Health Journal, 17, E18749445308945. https://doi.org/10.2174/0118749445308945240614110217
18. Szypłowska, M., Szydłowska, I., Wróbel, M., et al. (2023). The impact of endometriosis on quality of life, mental health, and emotional well-being: A systematic review. Frontiers in Public Health, 11, 1143470. https://doi.org/10.3389/fpubh.2023.1143470
19. Keckstein, J., Saridogan, E., Ulrich, U. A., Sillem, M., Oppelt, P., Schweppe, K. W., et al. (2021). The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstetricia et Gynecologica Scandinavica, 100(7), 1165–1175. https://doi.org/10.1111/aogs.14099
20. Nicolas-Boluda, A., Oppenheimer, A., Bouaziz, J., & Fauconnier, A. (2021). Patient-reported outcome measures in endometriosis: The Hospital Anxiety and Depression Scale (HADS) among other instruments. Journal of Clinical Medicine, 10(21), 5106. https://doi.org/10.3390/jcm10215106
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Алла Волянська, Ольга Кормілець
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
