ENDOMETRIOID OVARIAN CYSTS AND INFERTILITY: A MODERN APPROACH TO CLINICAL AND PROGNOSTIC ASPECTS (LITERATURE REVIEW)
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Abstract
Endometrioid ovarian cysts (endometriomas) are detected in 17-44% of women with genital endometriosis and are a significant cause of infertility. The complex impact of these lesions on reproductive function requires a detailed analysis of clinical and anamnestic factors and modern prognostic tools.
The aim of the research – to summarize current data on the clinical and anamnestic features of endometrioid ovarian cysts, the mechanisms of their impact on fertility, and to analyze approaches to surgical treatment, postoperative medical support, and the prediction of reproductive outcomes.
Materials and Methods. A literature review was conducted in the PubMed, Scopus, Web of Science, eLibrary, and CyberLeninka databases using the following keywords: «endometrioid ovarian cysts», «endometriosis», «infertility», «laparoscopic cystectomy», «dienogest», «bovhyaluronidase azoximer», «endometriosis fertility index (EFI)».
Results. The review summarizes current data on the clinical presentation of endometrioid ovarian cysts and the mechanisms of their negative impact on ovarian reserve and fertility. It is shown that laparoscopic cystectomy remains a key method for restoring fertility. Postoperative therapy with dienogest significantly reduces the recurrence rate (OR 0.24; 95% CI 0.15–0.37; p < 0.001). According to the network meta-analysis by Zheng Y. et al., dienogest ranks first in pregnancy rates among all postoperative endometriosis treatment regimens. The use of bovhyaluronidase azoximer in the combination therapy of endometriosis is associated with a more pronounced reduction in pain according to the VAS (p = 0.039) and a reduction in ultrasound signs of fibrotic changes (p = 0.041) compared with progestogen monotherapy. The endometriosis fertility index (EFI) is a reliable prognostic tool for determining patient management strategies.
Conclusion. The management of patients with endometrioid ovarian cysts and infertility requires a personalized, multidisciplinary approach. The most effective strategy is combination treatment: surgical removal of endometriomas followed by dienogest therapy and, if necessary, bovhyaluronidase azoximer to prevent fibrosis and adhesions. This not only prevents disease recurrence but also improves the chances of achieving pregnancy.
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