Abstract
Endometriosis affects approximately 10-15% of women of reproductive age and is found in 25-50% of infertile women. The optimal management strategy for endometriosis-associated infertility remains controversial, with both medical and surgical treatments offering potential benefits but different risk-benefit profiles. This systematic review aimed to compare the effectiveness of medical versus surgical treatment for endometriosis-associated infertility, focusing on pregnancy rates, live birth rates, and treatment-related complications. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library for studies published between 2013 and 2025. Eligible studies included randomized controlled trials and prospective cohort studies comparing medical therapy (hormonal suppression, gonadotropin-releasing hormone (GnRH) analogues) with surgical intervention (laparoscopic excision/ablation) in women with endometriosis-related infertility. Primary outcomes included clinical pregnancy rates, live birth rates, and time to conception. Nine studies involving 58,427 patients (including one large cohort study) were included. Surgical treatment combined with GnRH agonist therapy demonstrated superior outcomes compared to surgery alone, with effective rates of 62-86% versus 47%. However, ultra-long GnRH downregulation before assisted reproductive technologies (ART) showed no benefit over standard protocols. Pregnancy rates varied by endometriosis type, with superficial peritoneal endometriosis showing better post-surgical conception rates than deep infiltrating endometriosis. Combined surgical and medical treatment appeared more effective than either modality alone for endometriosis-associated infertility. However, treatment should be individualized based on endometriosis type, severity, and patient characteristics.

Key words: Endometriosis, infertility, laparoscopic surgery, fertility outcomes, systematic review