Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting approximately 10% of women of reproductive age. It is characterized by the presence of endometrial-like tissue outside the uterine cavity, commonly involving the ovaries, pelvic peritoneum, and surrounding structures. Endometriosis is strongly associated with infertility, affecting up to 50% of infertile women. The mechanisms by which endometriosis impairs fertility are multifactorial and include chronic pelvic inflammation, altered peritoneal environment, impaired tubal function, and disrupted folliculogenesis. Endometriomas, particularly when surgically removed, have been shown to negatively impact ovarian reserve, as reflected by reduced antral follicle count and anti-Müllerian hormone (AMH) levels. Furthermore, repeated surgical interventions may lead to significant loss of healthy ovarian tissue. The disease may also compromise oocyte quality and embryo development. Understanding the complex relationship between endometriosis and fertility is crucial for tailoring fertility-preserving strategies and optimizing assisted reproductive outcomes in affected patients.

The aim of this Research Topic is to provide a comprehensive and updated overview of the multifaceted impact of endometriosis on female fertility. Endometriosis, particularly in its ovarian and deep infiltrating forms, has been increasingly recognized not only as a pelvic inflammatory condition but also as a major cause of impaired reproductive function. The goal is to explore how endometriosis affects each stage of the reproductive process, starting with diminished ovarian reserve and poor ovarian response to stimulation, both of which significantly limit the success of Assisted Reproductive Techniques (ARTs). Special attention will be given to the compromised oocyte quality observed in women with endometriosis, which may contribute to lower fertilization rates, impaired embryo development, and reduced implantation. Furthermore, the collection may address the impact of coexisting adenomyosis, a condition frequently seen in patients with endometriosis, which further impairs endometrial receptivity and embryo implantation. The included articles aim to deepen our understanding of the pathophysiological mechanisms involved, highlight diagnostic and therapeutic challenges, and provide evidence-based recommendations for optimizing fertility outcomes in affected women. By gathering multidisciplinary contributions, this collection seeks to support clinicians and researchers in the development of personalized approaches to fertility preservation and management in endometriosis patients.

This Research Topic aims to explore the complex relationship between endometriosis and female fertility, providing new insights into its impact on reproductive outcomes and responses to treatment.

We invite contributions that explore the following themes:

• Reduced ovarian reserve and compromised oocyte quality

• Poor ovarian response to stimulation

• Effects of endometriosis-associated inflammation on embryo development and implantation.

• Role of adenomyosis in impairing endometrial receptivity, and to advances in fertility preservation strategies for affected patients.

We encourage the submission of Original Research articles and Reviews that focus on clinical, endocrinological, or translational aspects of endometriosis in the context of fertility. Our aim is to gather high-quality, multidisciplinary contributions that can improve clinical decision-making and support personalized reproductive care for women with endometriosis.

Are you interested in contributing a manuscript to this Research Topic?

Endometriosis: A Fertility Perspective