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

Recent studies [Donnez & Dolmans, 2022; Borrelli et al., 2022; Xu et al., 2023] emphasize the need 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: toevaluate the effectiveness of a personalized reproductive strategy in women with ovarian endometriosis, taking into account ovarian reserve, lesion morphology, and inflammatory biomarkers. Materials and methods.A total of 90 reproductive-aged women with histologically confirmed endometriosis were included. Depending on the treatment protocol, patients were assigned to one of three groups: Group I (n=30) underwent standard laparoscopic cystectomy followed by hormonal suppression; Group II (n=30) underwent organ-preserving resection with PRP hemostasis and ozone therapy; Group III (n=30) served as a control group without surgical intervention. AMH, IL-6, CA-125 levels, antral follicle count (AFC), clinical pregnancy rate, and recurrence within 24 months were assessed. Results. The clinical pregnancy rate in Group II was 63.3%, exceeding that in Group I (50.0%) and Group III (26.7%) (p < 0.01). The recurrence rate was lowest in Group II (10%) compared to Group I (16.7%) and Group III (30%). PRP and ozone therapy were associated with significant reductions in IL-6 (−47.8%) and CA-125 (−37%) (p < 0.05), indicating a strong anti-inflammatory effect. Group II also demonstrated preserved ovarian reserve, with > 6 AFC maintained one year post-treatment.Conclusions. The integration of fertility-preserving surgery, PRP-based hemostasis, and ozone therapy effectively reduces inflammatory burden, preserves ovarian reserve, and enhances fertility outcomes in women with endometriosis-associated infertility. These findings underscore the value of personalized multimodal strategies in managing endometriosis and support their wider adoption in clinical practice.Keywords: endometriosis, ovarian reserve, PRP, ozone therapy, anti-Müllerian hormone, CA-125, IL-6, infertility, ART, laparoscopy.