Endometriosis-Related Impairment in Assisted Reproductive Technologies: Inflammatory Profiles, Oocyte Competence, and Embryo Development

Background: Endometriosis is associated with infertility and impaired assisted reproductive technology (ART) outcomes, potentially due to an altered follicular microenvironment characterized by chronic inflammation. This study investigates the systemic and local inflammatory profiles in women with endometriosis and assesses their impact on oocyte and embryo quality using both static and dynamic embryo evaluation. Methods: A prospective, monocentric observational study enrolled 47 women undergoing controlled ovarian stimulation for ART, including 29 with laparoscopically confirmed endometriosis and 18 controls with tubal or male-factor infertility. Serum and follicular fluid cytokines (TGF-β1, NF-κB, IL-10, HIF-1α) were quantified. A sub-study analyzed embryo quality and development in 36 patients subdivided into static morphological assessment and dynamic time-lapse monitoring cohorts. Results: Endometriosis patients exhibited significantly elevated pro-inflammatory cytokines (TGF-β1, NF-κB) and reduced anti-inflammatory IL-10 in serum, alongside decreased NF-κB in follicular fluid. These alterations correlated with diminished ovarian reserve, reduced oocyte yield, and lower fertilization rates. Embryos from endometriosis patients showed increased multinucleation and persistent fragmentation, features more sensitively detected via dynamic time-lapse imaging. Clinical pregnancy rates were significantly lower in the endometriosis group. Conclusions: Endometriosis induces a dysregulated inflammatory follicular milieu that adversely affects oocyte competence and embryo morphodynamics. Dynamic embryo assessment provides enhanced detection of subtle developmental abnormalities. Integration of immunomodulatory strategies and advanced embryo monitoring may improve ART success in this population.