Adapted treatment strategy in women with endometriosis­associated infertility: a personalized reproductive approach

Abstract

DOI: 10.52705/2788-6190-2025-01.2-09
УДК: 618.177:618.1-089.888.11:615.37

Recent studies [Donnez & Dolmans, 2022; Borrelli et al., 2022; Xu et al., 2023] emphasize theneed for personalized approaches in the treatment of endometriosis, focusing on minimizing surgical trauma and controlling chronic inflammation. According to ESHRE guidelines (2022), the combination of conservative surgical techniques with adjuvant therapy (PRP, ozone, dienogest) helps preserve ovarian function and improve reproductive outcomes.The treatment strategy proposed in this study aligns with these principles and demonstrates the clinical value of integrating modern innovations into practice. The combined use of fertility-preserving surgery, PRP-based hemostasis, and ozone therapy was effective in reducing inflammatory load, preserving ovarian reserve, and improving fertility outcomes in women with endometriosis-associated infertility. These results confirm the relevance of a personalized, multimodal approach to the comprehensive management of this condition.

The objective: to evaluate the effectiveness of a personalized reproductive strategy in womenwith ovarian endometriosis, taking into account ovarian reserve, lesion morphology, andinflammatory biomarkers.

Materials and methods. A total of 90 reproductive-aged women with histologically confirmedendometriosis were included. Depending on the treatment protocol, patients were assignedto one of three groups: Group I (n=30) underwent standard laparoscopic cystectomy followedby hormonal suppression; Group II (n=30) underwent organ-preserving resection with PRPhemostasis and ozone therapy; Group III (n=30) served as a control group without surgicalintervention. AMH, IL-6, CA-125 levels, antral follicle count (AFC), clinical pregnancy rate, andrecurrence within 24 months were assessed.

Results. The clinical pregnancy rate in Group II was 63.3%, exceeding that in Group I (50.0%) andGroup III (26.7%) (p < 0.01). The recurrence rate was lowest in Group II (10%) compared to GroupI (16.7%) and Group III (30%). PRP and ozone therapy were associated with significant reductionsin IL-6 (−47.8%) and CA-125 (−37%) (p < 0.05), indicating a strong anti-inflammatory effect. GroupII also demonstrated preserved ovarian reserve, with > 6 AFC maintained one year post-treatment.

Conclusions. The integration of fertility-preserving surgery, PRP-based hemostasis, and ozonetherapy effectively reduces inflammatory burden, preserves ovarian reserve, and enhancesfertility outcomes in women with endometriosis-associated infertility. These findings underscorethe value of personalized multimodal strategies in managing endometriosis and support theirwider adoption in clinical practice.