Endometriosis may harm fertility through damage to egg quality, review finds

Endometriosis, a gynaecological condition that can lead to infertility, appears to impair fertility largely by damaging the quality of eggs rather than by affecting the uterus, according to a narrative review published in Molecular Biology Reports. The authors, Lipsa Samal, Chidananda Dash and Sujata Pradhan, summarise how the disease creates an unfavourable environment inside the ovarian follicle, where eggs mature before ovulation.

According to the review, this hostile follicular microenvironment arises from inflammation, oxidative stress, dysfunction of the granulosa and cumulus cells that surround the egg, and hormonal dysregulation. At the subcellular level, the authors report that endometriosis is associated with spindle disorders, breakdown of mitochondrial DNA, and delayed cytoplasmic maturation of the oocyte. These mechanisms are presented as the pathways through which the disease may compromise egg quality.

The clinical picture described in the review is most pronounced in advanced disease. Women with stage III-IV endometriosis have low ovarian reserve, fewer retrieved and matured oocytes, and lower fertilisation and blastocyst development rates, which the authors link to worse cumulative pregnancy outcomes. Importantly, the review notes that when good-quality embryos are transferred, implantation and live birth rates are often similar to those of controls. The authors interpret this pattern as suggesting that the fertility problem in endometriosis is primarily oocyte-driven rather than related to the endometrium, the lining of the uterus.

On the therapeutic side, the review outlines options that include lifestyle modifications such as a healthy diet, yoga, exercise, adequate sleep and stress management, alongside individualised assisted reproductive technology treatments intended to enhance prognosis. The authors are careful to characterise these approaches as having sub-optimal proven mechanisms, meaning the evidence for how they work remains incomplete. As a narrative review, the article synthesises existing literature rather than presenting new clinical trial data, and its conclusions reflect that scope. The work was published on 3 September 2026 as part of Volume 53 of the journal.

Subject of Research: Mechanisms by which endometriosis affects oocyte quality and fertility, and therapeutic options

Article Title: Oocyte quality in endometriosis-associated infertility: a narrative analysis of mechanisms and therapeutic options

Article References: Samal, L., Dash, C., & Pradhan, S. (2026). Oocyte quality in endometriosis-associated infertility: a narrative analysis of mechanisms and therapeutic options. Molecular Biology Reports, 53(1), Article 1518. https://doi.org/10.1007/s11033-026-12714-w

Image Credits: AI Generated

DOI: 10.1007/s11033-026-12714-w

Keywords: endometriosis, oocyte quality, infertility, ovarian reserve, oxidative stress, mitochondrial DNA, assisted reproductive technology, granulosa cells, blastocyst development, narrative review, Oocyte, quality