Optimizing management strategy in infertile patients with ovarian endometriosis

Aim. To develop a personalized approach to managing infertile patients with stage III-IV ovarian endometriosis based on the clinical picture, the state of the endometrium, and ovarian reserve. Materials and methods. The study included 147 infertile women with stages III-IV ovarian endometriotic cysts (OEC). Group I consisted of 49 patients who underwent surgery followed by the expectation of spontaneous pregnancy and IVF. Group II comprised 98 patients with personalized management, including preoperative hormonal therapy with GnRH agonist or dienogest, surgery for OEC followed by the expectation of spontaneous pregnancy against the background of cyclic dydrogesterone administration (IIA subgroup, n=40) or complex treatment with dienogest, NSAID, cavity magneto-therapy, central color rhythm therapy, electrical nerve stimulation and expectation of spontaneous pregnancy and IVF (IIB subgroup, n=43). Patients in the IIC subgroup with a critical ovarian reserve (n=15) underwent IVF with oocyte donation. Results. Perioperative hormonal treatment was statistically significantly associated with the preservation and quality of the ovarian reserve, OEC size reduction by 42.5%, and endometrial receptivity and cytokine status normalization. A differentiated approach to the management of infertile patients with severe forms of OEC was associated with a 2-fold increase in the pregnancy rate (ABI 20.2% [95% CI 2.7-34.5], RR 2.04 [95% CI 1.04-4.01], p <0.001) and a 2.9-fold increase in live birth rate (ABI 23.9% [95% CI 7.6-36.7], RR 2.96[95% CI 1.24-7.08], p <0.001). Conclusion. The study findings objectified the rationality of personalized management of patients with severe OEC compared with patients without an individual approach to infertility treatment.

ovarian endometriosis, stage III-IV endometriotic ovarian cysts, infertility, personalized treatment, perioperative hormonal treatment, evidence-based medicine