Prognostic Assessment of Fertility Potential in Women with Endometriosis

Abstract

Aim. To identify and evaluate clinical, hormonal, biochemical, and molecular markers that can predict fertility potential and reproductive outcomes in women with endometriosis.

Materials and Methods. The study included 58 women aged 25–48 years with external genital endometriosis and 20 healthy fertile controls. Diagnosis was based on clinical assessment, ultrasound, and, when available, intraoperative findings. Clinical evaluation included reproductive history, infertility duration, and pain severity assessed by VAS. Hormonal analysis included AMH, FSH, LH, and estradiol levels. Oxidative stress markers (MDA, SOD, TAC), cytokines (IL-6, TNF-α, IL-10), apoptosis-related proteins (Bax, Bcl-2, caspase-3), and microRNA expression (miR-21, miR-200, miR-135a/b) were assessed using ELISA and qRT-PCR. Disease severity was classified using rASRM, Enzian, AAGL systems, and reproductive prognosis was evaluated using the Endometriosis Fertility Index (EFI). Statistical analysis included comparative tests, correlation analysis, logistic regression, and ROC analysis.

Results. Infertility was observed in 79.3% of women with endometriosis, with a mean duration of 4.3 ± 1.7 years. AMH levels were significantly lower compared with controls (1.9 ± 0.7 vs 2.8 ± 0.9 ng/mL, p < 0.01), indicating reduced ovarian reserve. Increased oxidative stress was confirmed by elevated MDA and decreased antioxidant parameters (SOD, TAC). Pro-inflammatory cytokines (IL-6, TNF-α) were significantly elevated, while IL-10 levels were reduced. Molecular analysis showed increased miR-21 and miR-135a/b expression and decreased miR-200 levels, associated with disease severity and infertility. Moderate and severe endometriosis accounted for over 60% of cases. EFI scores indicated low reproductive prognosis in 19.0%, moderate in 43.1%, and favorable in 37.9% of patients. Logistic regression identified reduced AMH, elevated IL-6, increased MDA, and altered microRNA expression as key predictors of unfavorable reproductive outcomes. ROC analysis demonstrated good predictive performance of the integrated model.

Conclusion. Endometriosis-associated infertility is determined not only by anatomical disease extent but also by systemic inflammation, oxidative stress, reduced ovarian reserve, and dysregulated microRNA expression. Integration of clinical, hormonal, and molecular markers significantly improves prognostic assessment and supports personalized reproductive management in women with endometriosis.