Fertility preservation in endometriosis: evaluating surgical risks and emerging preservation approaches

Endometriosis poses significant challenges for women of reproductive age, particularly due to its impact on ovarian reserve and fertility. In addition to endometriosis-associated infertility contributing to diminished ovarian reserve by inflammation and oxidative stress, surgical interventions, often required to manage endometriosis, can exacerbate ovarian damage, further complicating fertility preservation. This narrative review critically examines the interplay between endometriosis treatment and fertility preservation strategies, offering insights into current surgical risks and emerging approaches to mitigate their impact on reproductive potential. Furthermore, it explores traditional fertility preservation methods, including oocyte, embryo and ovarian tissue cryopreservation, alongside advances in vitrification techniques that enhance success rates. Innovative minimally invasive surgical techniques, such as carbon dioxide laser vaporization, plasma energy ablation, haemostatic sealants, and robotic-assisted laparoscopy, are evaluated for their ability to preserve ovarian tissue. Moreover, emerging trends, including the use of artificial intelligence for personalized treatment planning and bioengineering innovations, such as three-dimensional-printed ovarian scaffolds, are discussed as transformative solutions for restoring fertility. A multi-disciplinary, patient-centred approach is emphasized, integrating expertise from gynaecology, reproductive endocrinology, and bioengineering to optimize fertility preservation outcomes. By bridging technological advances and clinical practice, this review aims to provide a framework for preserving fertility while addressing the complex challenges of endometriosis.