ВПЛИВ ЕНДОМЕТРІОЗУ НА ОВАРІАЛЬНИЙ РЕЗЕРВ І РЕПРОДУКТИВНУ ФУНКЦІЮ ЖІНОК: ОГЛЯД СУЧАСНИХ ДАНИХ
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This review analyzes current evidence demonstrating that ovarian endometriosis reduces ovarian reserve and reproductive outcomes through inflammation and mechanical damage, while highlighting the limited predictive value of anti-Müllerian hormone for spontaneous conception.
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This review analyzes literature to evaluate how endometriosis impacts ovarian reserve and reproductive function in women. The authors identify that ovarian endometriomas reduce anti-Müllerian hormone levels through mechanisms involving inflammation, oxidative stress, tissue fibrosis, and mechanical destruction of ovarian tissue. While combined surgical technologies show improved outcomes for recurrence and pregnancy rates, the paper cautions that spontaneous pregnancy prognosis should not rely solely on AMG indicators. This paper is centrally about endometriosis — specifically the pathophysiological impact of ovarian endometriomas on fertility and ovarian reserve.
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Abstract
Objective. To evaluate the impact of endometriosis on ovarian reserve and to analyze the mechanisms underlying its detrimental effects on ovarian function based on current literature. Materials and Methods. This review included original studies, systematic reviews, meta-analyses, and clinical guidelines published in Ukrainian and English. Relevant publications were identified by searching PubMed, Scopus, Google Scholar, and the Cochrane Library using keywords such as endometriosis, fertility, pathophysiology, endometrioma, ovarian reserve, and surgery. Results and Discussion. The review summarizes current evidence on endometriosis-associated infertility, focusing on the impact of endometriomas on ovarian reserve. Ovarian endometriosis negatively affects ovarian reserve and reproductive outcomes. Anti-Müllerian hormone (AMH) is a key marker in clinical assessment. Most studies demonstrate reduced AMH levels in patients with endometriomas even before surgery, indicating primary ovarian damage caused by chronic inflammation, oxidative stress, fibrosis, and mechanical follicular loss. Comparative analyses show that combined surgical approaches are associated with lower recurrence rates and higher spontaneous pregnancy rates than ablative techniques. However, reproductive prognosis should not rely solely on AMH. Evidence suggests its limited predictive value for spontaneous conception, while a comprehensive assessment of infertility factors provides more accurate prediction of reproductive outcomes. Conclusions. Endometriosis-associated infertility is multifactorial. Management should be individualized and based on an integrated evaluation of clinical, historical, hormonal, ultrasonographic, and surgical factors to improve reproductive outcomes.
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ВПЛИВ ЕНДОМЕТРІОЗУ НА ОВАРІАЛЬНИЙ РЕЗЕРВ І РЕПРОДУКТИВНУ ФУНКЦІЮ ЖІНОК: ОГЛЯД СУЧАСНИХ ДАНИХ
DOI:
https://doi.org/10.32782/2226-2008-2026-2-12Ключові слова:
ендометріоз, безпліддя, оперативна гінекологія, гінекологія, гінекологічна хірургія.Анотація
Мета роботи – оцінити вплив ендометріозу на оваріальний резерв і механізми впливу захворювання на стан яєчників за даними літератури. Проаналізовано оригінальні дослідження, огляди, метааналізи та клінічні настанови (PubMed, Scopus, Google Scholar та Cochrane). Результати дослідження показали, що ендометріоз яєчників негативно впливає на оваріальний резерв і репродуктивні результати пацієнток із безпліддям. Рівень АМГ знижений у пацієнток з ендометріомами до оперативного втручання, що свідчить про ураження оваріальної тканини через запалення, оксидативний стрес, фіброз тканини яєчника та його механічне руйнування. Комбіновані хірургічні технології мають кращі результати щодо рецидивів і вагітності. Прогноз настання спонтанної вагітності не слід базувати лише на показниках АМГ. Пацієнки з ендометріоз-асоційованим ендометріозом потребують мультифакторного підходу.
Посилання
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