Women with endometriosis who undergo IVF: a contemporary review of therapeutic strategies for successful outcomes

Sep 29, 2026

Uploaded by Aran

Endometriosis is a challenging chronic gynecologic condition, further complicated when infertility history coexists with progression to in-vitro fertilization (IVF). The review addresses specific hurdles in preparing for and performing IVF, particularly in the presence of endometriomas and advanced disease (rASRM stages III–IV). It synthesizes contemporary approaches to improve IVF outcomes, including medical and surgical strategies, timing to reduce disease burden, ovulation induction optimization to increase egg/embryo yield, and interventions to maximize implantation success after embryo transfer.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Abstract

Introduction

Kotlyar and Seifer Reproductive Biology and Endocrinology (2026) 24:1 [https://doi.org/10.1186/s12958-025-01506-9](https://doi.org/10.1186/s12958-025-01506-9) Reproductive Biology and Endocrinology REVIEW Open Access Women with endometriosis who undergo IVF: a contemporary review of therapeutic strategies for successful outcomes Alexander M. Kotlyar 1,2* and David B. Seifer3 Abstract Background Endometriosis remains one of the most challenging chronic conditions to treat in gynecology. This condition is further complicated when patients concomitantly present with a history of infertility even though many will eventually progress to treatment with in-vitro fertilization (IVF) . However, endometriosis presents its own unique set of challenges when preparing a patient for and performing an IVF cycle. This is especially the case when endometriomas are present and contribute to the diagnosis of advanced stage endometriosis (revised ASRM classification system, stages III-IV) . Main text In this review, we provide a summary of contemporary strategies to optimize IVF outcomes for patients with this systemic disease. Such strategies range from efforts and timing of such efforts to reduce disease burden via medical and surgical approaches, methods to optimize ovulation induction for maximizing egg/embryo yield as well as strategies to maximize success of implantation during embryo transfer. In addition, we delve into future strategies to reduce endometriosis disease burden which have the potential to improve IVF outcomes. Conclusion This review provides a contemporary approach to optimizing IVF outcomes in patients with endometriosis of various stages. Keywords Endometriosis, Endometriomas, In-vitro fertilization, Egg/embryo cryopreservation, Frozen thaw embryo transfer, Optimizing outcomes Introduction Endometriosis is one of the most insidious causes of chronic pelvic pain and remains one of the toughest issues for patients struggling with infertility [1]. It is characterized by ectopic endometrium composed of benign glands and stroma found outside the uterine cavity. Histologically there are endometrial glands and stroma often *Correspondence: Alexander M. Kotlyar [Vostok6186@gmail.com](Vostok6186@gmail.com) 1Genesis Fertility and Reproductive Medicine, Brooklyn, NY, USA 2SUNY-Downstate School of Medicine, Brooklyn, NY, USA 3Yale School of Medicine, Yale University, New Haven, CT, USA accompanied by the presence of hemosiderin-laden macrophages. The definitive diagnosis is surgical requiring confirmation by biopsy but often is made visually during laparoscopy. The severity of the disease is defined as minimal (Stage 1), mild (Stage 2), moderate (Stage 3) or severe (Stage 4) according to the revised American Society of Reproductive Medicine (rASRM) staging system [2]. Advanced stages 3 and 4 are associated with greater frequency of infertility and poorer fertility treatment outcomes than Stages 1 and 2 [3]. While the exact pathogenesis of endometriosis is unknown, there are several theorized suspected causes. The most accepted theory is that of retrograde © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exce

FAQs

Why is endometriosis especially challenging during IVF cycles?

Endometriosis can complicate both preparation for and performance of IVF, with added difficulties when endometriomas are present and when patients have advanced disease stages (rASRM III–IV).

What outcome areas does the review focus on to improve IVF success?

It covers strategies to reduce disease burden through medical and surgical approaches, optimize ovulation induction to maximize egg/embryo yield, and improve implantation success during embryo transfer.

How is disease severity classified in the review’s introduction?

Severity is defined using the revised American Society of Reproductive Medicine (rASRM) staging system: minimal (Stage 1), mild (Stage 2), moderate (Stage 3), and severe (Stage 4), with Stages 3–4 linked to worse fertility outcomes.

Sep 29, 2026

Uploaded by Aran