Background and Objectives: Endometriosis is a chronic, estrogen-dependent disorder characterized by the presence of functional endometrial tissue, comprising both glandular and stromal components, located outside the uterine cavity, affecting approximately 6–10% of women of reproductive age and up to 30–50% of those with infertility. Increasing evidence indicates that endometriosis is not solely a localized gynecological condition but rather a systemic inflammatory and immune-mediated disease. Chronic inflammation and immune dysregulation contribute to disease progression and may impair reproductive function. This review aims to analyze the current evidence regarding the inflammatory and immunological mechanisms underlying endometriosis and to evaluate their impact on reproductive dysfunction and assisted reproductive technology (ART) outcomes. Materials and Methods: A comprehensive narrative review was conducted using major scientific databases, including PubMed, Scopus, and Web of Science. Relevant articles published in the last decade were selected using keywords such as “endometriosis”, “inflammation”, “immune response”, “cytokines”, and “ART outcomes”. Both clinical and experimental studies were included to assess the relationship between inflammatory markers, immune alterations, and reproductive performance. Results: Endometriosis is associated with elevated levels of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α), as well as increased oxidative stress and altered peritoneal microenvironment. Immune dysfunction is characterized by activated macrophages, decreased natural killer (NK) cell cytotoxicity, and an imbalance in T-cell populations. These alterations negatively affect oocyte quality, fertilization, embryo development, and endometrial receptivity. Emerging biomarkers such as IL-6, TNF-α, and CA-125 show potential in predicting disease severity and ART outcomes, although their clinical utility remains under investigation. Conclusions: Endometriosis should be regarded as a systemic immuno-inflammatory disorder with significant implications for reproductive health. The interaction between chronic inflammation and immune dysregulation plays a central role in infertility and suboptimal ART outcomes. Further research is required to validate reliable biomarkers and develop targeted therapeutic strategies to improve reproductive success in affected patients.

Background and Objectives: Endometriosis is a multifactorial gynecological condition associated with impaired fertility; however, its impact on embryo competence remains incompletely understood. This study aimed to evaluate embryo competence through a stepwise analysis of IVF outcomes across the developmental continuum, while also comparing patients with endometriosis and controls. Materials and Methods: A retrospective observational study was conducted, including 160 patients undergoing IVF, comprising 55 patients with endometriosis and 105 controls. Clinical and embryological data were analyzed sequentially across key developmental stages, including oocyte retrieval, metaphase II (MII) oocyte formation, fertilization (2PN), embryo development, and euploidy in a subgroup undergoing preimplantation genetic testing for aneuploidy (PGT-A). Stage-specific efficiency rates were calculated, and correlations between early- and late-developmental parameters were assessed. In addition, comparative analysis between groups was performed. Results: A progressive decline in developmental efficiency was observed across the IVF continuum, with approximately one-quarter of retrieved oocytes reaching the embryo stage and only a small proportion ultimately resulting in euploid Blastocysts. Strong positive correlations were identified among early-stage parameters, particularly retrieved oocytes, MII oocytes, and embryo yield (r = 0.77–0.96, p < 0.001), indicating that ovarian response and oocyte maturity significantly influence downstream outcomes. However, efficiency-based parameters showed limited predictive value for chromosomal competence. A moderate association was observed between MII oocytes and euploid Blastocysts (r = 0.58), whereas the relationship between embryo number and euploidy remained weak. Comparative analysis revealed no statistically significant differences between the endometriosis and control groups across the evaluated embryological parameters (p > 0.05 for all comparisons), suggesting that sequential analyses may provide complementary insight beyond direct comparisons. Conclusions: IVF outcomes follow a sequential developmental trajectory with a progressive decline in efficiency across stages. In endometriosis, early developmental competence appears to be affected, while chromosomal competence remains relatively preserved.

Background/Objectives: Endometriosis is frequently associated with infertility and may affect several aspects of reproductive competence. However, whether women with endometriosis exhibit different preimplantation genetic testing for aneuploidy (PGT-A) outcomes compared with women without endometriosis remains uncertain. This study aimed to compare the distribution of PGT-A chromosomal outcomes—including euploid, mosaic, aneuploid, and complex aneuploid results—between women with and without endometriosis undergoing IVF. Methods: This retrospective observational study included 160 women who underwent IVF treatment between January 2023 and January 2026, including 55 women with endometriosis and 105 controls without evidence of endometriosis. A total of 129 blastocysts underwent trophectoderm biopsy and PGT-A, of which 120 yielded conclusive chromosomal results. PGT-A outcomes were classified as euploid, mosaic, aneuploid, or complex aneuploid. The overall distribution of the four PGT-A outcome categories was compared between groups using an unadjusted chi-square test. Results: Among blastocysts with conclusive PGT-A results, the proportions of euploid, mosaic, aneuploid, and complex aneuploid embryos were 31.6%, 18.4%, 26.3%, and 23.7%, respectively, in the endometriosis group and 42.7%, 14.6%, 25.6%, and 17.1%, respectively, in the control group. The overall distribution of PGT-A chromosomal outcome categories did not differ significantly between groups (χ² = 1.65, df = 3, p = 0.648). Conclusions: In this retrospective cohort, no statistically significant difference was observed in the overall distribution of PGT-A chromosomal outcomes between women with endometriosis and controls. Although numerical differences were observed across individual outcome categories, the absence of statistical significance should not be interpreted as evidence of equivalence between the groups, particularly given the limited precision of the estimates. Larger patient-level studies accounting for within-patient clustering and relevant clinical and embryological confounders are needed to further clarify the relationship between endometriosis and PGT-A outcomes.

Background and Objectives: Endometriosis is a chronic inflammatory disease associated with impaired fertility, but the extent to which its systemic inflammatory profile differs from that observed in infertile women without endometriosis remains incompletely understood. This study aimed to characterize and compare the systemic inflammatory profiles of women with endometriosis, infertile women without endometriosis, and healthy controls by evaluating serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP). In addition, the study explored the IL-6/TNF-α ratio as an indicator of inflammatory balance and evaluated its relationship with ovarian reserve. Materials and Methods: This observational comparative study included 87 women divided into three groups: healthy controls (n = 29), women with endometriosis (n = 29), and infertile women without endometriosis (n = 29). Serum IL-6, TNF-α, and hs-CRP concentrations were determined specifically for the present study, whereas the corresponding clinical and embryological data were retrieved from medical records. Group comparisons were performed using the Kruskal–Wallis test followed by Dunn’s post hoc test with Holm correction. The IL-6/TNF-α ratio was calculated as an exploratory indicator of inflammatory balance. Associations between inflammatory biomarkers and anti-Müllerian hormone (AMH) concentrations were assessed using Spearman’s correlation analysis. Results: Significant differences in serum inflammatory biomarkers were observed among the three groups. IL-6 concentrations were significantly increased in both women with endometriosis and infertile women without endometriosis compared with healthy controls, whereas TNF-α concentrations were significantly elevated only in infertile women without endometriosis compared with both healthy controls and women with endometriosis (adjusted p < 0.001 for both comparisons). Differences in hs-CRP were more modest but remained significant overall. Women with endometriosis exhibited a significantly higher IL-6/TNF-α ratio than infertile women without endometriosis, suggesting distinct inflammatory patterns between these conditions. No significant correlations were identified between circulating inflammatory biomarkers and AMH concentrations. Conclusions: Women with endometriosis and infertile women without endometriosis exhibit distinct systemic inflammatory profiles rather than simply different levels of inflammation. The IL-6/TNF-α ratio may provide additional information regarding the balance of inflammatory pathways beyond the isolated evaluation of individual cytokines. Larger prospective studies integrating systemic and local inflammatory biomarkers with assisted reproductive outcomes are warranted to validate these findings and further explore their clinical relevance.

Background/Objectives: Premature ovarian insufficiency (POI) affects approximately 3.5% of women with lifelong bone, cardiovascular, psychological and reproductive consequences. International guidance assigns primary care important roles in recognition, diagnosis and follow-up. This review mapped evidence across the POI care continuum. Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR, PubMed/MEDLINE, Scopus and Web of Science were searched from inception to 4 October 2026. Two reviewers independently screened records and assessed full texts. Data were charted by one reviewer, verified by a second and synthesised across five domains. Results: Of 1327 records (806 after deduplication), 91 full texts were assessed and 53 sources included (31 empirical; 22 secondary/prescriptive). Primary-care guidance was common, but empirical evidence from primary care was limited. Diagnostic delay of months to years was reported, and in one survey more than half of women consulted three or more clinicians before diagnosis. In one physician survey, supported by a smaller pilot survey, primary care physicians initiated hormone therapy less often than specialists, and gaps in long-term follow-up persisted. No formally evaluated shared-care model was identified. Conclusions: Primary care is central to recommended POI care, but implementation remains poorly studied. Research should quantify real-world primary care performance and test structured interdisciplinary pathways.