Fertility restoration in women with infertility associated with ovarian endometriomas: a retrospective study

Objective. To investigate the clinical and historical characteristics, instrumental and laboratory findings in patients with infertility associated with ovarian endometriomas after surgical treatment, and to identify factors influencing fertility restoration. Materials and methods. A total of 80 patients with a confirmed diagnosis of infertility associated with ovarian endometriomas were examined. The assessment included history taking, general and gynecological examinations, and ultrasound using a Logiq S8 device (USA) with an E8C-RS transvaginal probe (4–11 MHz) evaluating the pattern of ovarian involvement (unilateral or bilateral) and cyst sizes (cm). Clinical and laboratory testing comprised measurement of plasma concentrations of AXIN-1, CYFRA-21-1, and haptoglobin by enzyme-linked immunosorbent assay (ELISA) using SEC191Hu ELISA Kit (CLOUD-CLONE CORP, USA), ELISA Kit for Cytokeratin Fragment Antigen 21-1 (CLOUD-CLONE CORP, USA), and Human Haptoglobin ELISA Kit (Assaypro LLC, USA). Blood samples were collected before surgery, on postoperative day 10, and 6 months after surgical intervention. Surgical treatment was performed by laparoscopic approach using Karl Storz equipment (Germany) with salpingo-ovariolysis, cystectomy, chromotubation, and hysteroscopy. After a 12-month postoperative follow-up, patients were divided into two groups according to fertility restoration: those who achieved pregnancy (n = 35) and those who did not (n = 45). MedCalc software, version 23.2.1 (MedCalc Software Ltd., Belgium) was used for analysis and processing of quantitative data. Results. Ultrasound examination revealed that bilateral ovarian involvement was associated with impaired restoration of natural fertility. Laboratory investigation demonstrated a negative correlation between AXIN-1 protein levels at six months post-surgery and the probability of pregnancy, as well as a positive correlation between CYFRA-21-1 levels at six months post-surgery and preoperative haptoglobin levels with pregnancy achievement. ROC analysis determined threshold values of the biomarkers for predicting fertility restoration: AXIN-1 ≤ 1.16 ng/mL, CYFRA-21-1 0.25 ng/mL, haptoglobin 779 mg/L. Based on the identified statistically significant laboratory parameters (AXIN-1 and haptoglobin levels) and the pattern of ovarian involvement, along with additional predictors of lower statistical significance — **clinical history data** (chronic pelvic pain) and **ultrasound parameters** (total cyst size) — a prognostic model for fertility restoration was developed with a specificity of 79,1 % and an accuracy of 76,0 %. Conclusions. A comprehensive assessment of clinical history, ultrasound, and laboratory data allowed the identification of key prognostic criteria for the restoration of reproductive function in patients with infertility associated with ovarian endometriomas. The developed prognostic model may serve as a valuable tool for determining the optimal treatment strategy for infertility in this patient cohort. However, further studies are needed to validate the model in larger samples and to assess its applicability in various clinical settings.