Endometriosis in IVF/ICSI: Clinical Outcomes, Cumulative Live Birth, and a Pragmatic Narrative Review for Patient Counseling and Management

This pragmatic narrative review provides a phenotype-informed framework for counseling and managing women with endometriosis undergoing IVF/ICSI, with emphasis on cumulative live birth and preservation of ovarian reserve. A focused literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar, covering studies published from 2021 to 2026 and including selected earlier landmark studies when relevant. Evidence was synthesized according to disease phenotype, the presence of adenomyosis, prior surgery, and key reproductive outcomes, including ovarian response, embryo cohort size, implantation, and cumulative live birth. Endometriosis appears to act predominantly as a quantitative ovarian constraint, characterized by reduced anti-Müllerian hormone levels, lower antral follicle count, and decreased oocyte yield, particularly in women with ovarian endometrioma or prior cystectomy. Fertilization and embryo competence are generally preserved, suggesting that the main limitation is embryo cohort size rather than intrinsic embryo quality. Implantation may be modestly impaired in selected phenotypes, especially in the presence of adenomyosis, whereas live birth per transfer may remain broadly comparable after adjustment. Adenomyosis is heterogeneous, and its variable presentation may influence reproductive outcomes and treatment response. Endometriosis does not preclude successful IVF/ICSI. Counseling should therefore emphasize cumulative outcomes, preservation of ovarian reserve, and avoidance of unnecessary ovarian surgery within a pragmatic, phenotype-informed management strategy.