INFERTILITY IN WOMEN WITH ENDOMETRIOSIS: MECHANISMS, BIOMARKERS AND CONTEMPORARY MANAGEMENT STRATEGIES – A REVIEW

Barbara Tomaszek; Aleksandra Blok; Kamila  Kapłon; Gabriela Kapłon; Dominika Gieroba; Anna Kamieniak; Remigiusz  Flakus; Karolina Glajcar; Wiktor Werenkowicz

doi:10.31435/ijitss.1(49).2026.4840

Authors

Barbara Tomaszek Samodzielny Publiczny Zakład Opieki Zdrowotnej w Przeworsku, Przeworsk, Poland https://orcid.org/0009-0001-8477-0007
Aleksandra Blok Samodzielny Publiczny Zakład Opieki Zdrowotnej w Przeworsku, Przeworsk, Poland https://orcid.org/0009-0001-0813-0366
Kamila Kapłon Medical University of Lublin, Lublin, Poland https://orcid.org/0009-0002-8355-2742
Gabriela Kapłon NZOZ Przychodnia na Biskupinie Sp. z o.o., Wrocław, Poland https://orcid.org/0009-0005-1985-318X
Dominika Gieroba Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0009-0006-3454-1595
Anna Kamieniak University Clinical Hospital No 4 in Lublin, Lublin, Poland https://orcid.org/0009-0006-1217-0658
Remigiusz Flakus Regional Blood Donation and Transfusion Centre in Wrocław, Wrocław, Poland https://orcid.org/0009-0008-7890-3521
Karolina Glajcar University Clinical Hospital in Wroclaw, Wrocław, Poland https://orcid.org/0009-0007-2496-0793
Wiktor Werenkowicz Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0008-8487-2426

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4840

Keywords:

Endometriosis, Infertility, Immune Dysregulation, GnRH Antagonists, Quality of Life

Abstract

Introduction: Endometriosis is a chronic inflammatory disorder that affects approximately 6–10% of women of reproductive age and is found in up to 50% of those assessed for infertility. While advanced stages of the disease can compromise fertility through the formation of adhesions and anatomical distortions, clinically significant infertility can also occur in cases of minimal or mild endometriosis, highlighting the role of non-anatomical factors. Current evidence suggests that immune dysregulation, progesterone resistance, chronic endometrial inflammation, oxidative stress, and microbiome disturbances contribute to impaired implantation and diminished reproductive potential.

Objectives: This narrative review synthesizes current mechanistic and clinical evidence regarding endometriosis-related infertility, focusing on molecular pathways, evolving diagnostic methodologies, and fertility-oriented treatment strategies.

Methods: We searched PubMed, Scopus, and Google Scholar for publications from 2018 to 2025 on endometriosis and infertility. Priority was given to international clinical guidelines, systematic reviews, meta-analyses, and original studies addressing pathophysiology, diagnostics, fertility interventions (including surgery and assisted reproduction), and quality-of-life outcomes. A narrative synthesis was performed.

Results: Endometriosis shares key molecular and immunologic features with recurrent implantation failure, such as aberrant macrophage activation, T-cell imbalances, and impaired endometrial receptivity. Oral GnRH antagonists offer new options for symptom control while preserving flexibility in fertility planning. Emerging therapies target inflammation, immune pathways, and the endometrial microbiome. Ongoing trials (e.g., surgery-first vs. IVF-first) may identify optimal treatment sequences. However, delayed diagnosis and unequal access to fertility care remain major challenges worldwide.

Conclusions: Infertility associated with endometriosis is multifactorial and requires an individualized, multidisciplinary approach that integrates reproductive goals, symptom management, and psychosocial well-being. Further validation of biomarker panels and comparative-effectiveness studies is essential to refine clinical algorithms and enhance reproductive outcomes.

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