Introduction

Endometriosis is not just a physical condition; it has a wide-ranging impact on women’s mental health, quality of life, and social relationships. Chronic pain, infertility, and emotional problems reduce life satisfaction and daily productivity. Management of this condition must go beyond treating physical symptoms and address psychological and social aspects as well.

Physical effects

1. Chronic pain

• Severe pelvic pain and dysmenorrhea.

• Pain during sexual intercourse (dyspareunia).

• Chronic menstrual pain that disrupts daily life.

2. Infertility

• About 30 to 50 percent of women with endometriosis experience fertility problems.

• Increased anxiety and stress caused by unsuccessful attempts to conceive.

Psychological effects

1. Anxiety and depression

• Constant worry about the severity of the pain and the progression of the disease.

• Feeling helpless and unmotivated.

2. Decreased self-confidence

• Body changes, sexual limitations, and fertility all contribute to a diminished self-image.

3. Sleep problems

• Chronic pain causes sleep disturbance and chronic fatigue.

Social impacts

• Limitation of social and work activities.

• Pressure on marital and family relationships.

• Feelings of isolation and reduced participation in society.

Comprehensive disease management

1. Medical treatment

• Medication, surgery, and combination therapies to control physical symptoms.

2. Psychological support

• Individual and group counseling for managing anxiety and depression.

• Cognitive-behavioral psychotherapy (CBT) techniques.

3. Lifestyle and physical activity

• Regular exercise and physical activity to reduce pain and improve mood.

• Healthy eating and anti-inflammatory diet.

4. Support groups

• Connecting with other women with endometriosis.

• Exchange of experience and psychological support.

5. Pain management and complementary methods

• Yoga, meditation, and acupuncture to reduce pain and stress.

Conclusion

A multidimensional approach is essential to improve the quality of life of women with endometriosis. This approach must consider both the physical health, mental health, and social relationships of women. Successful treatment is not limited to pain relief; it also includes psychological support, lifestyle modifications, and the creation of a social support network.

Suggested References

• Human Reproduction Update (2024): Impact of endometriosis on quality of life

• Fertility and Sterility Journal: Psychological and social aspects of endometriosis

Introduction

The uterine microbiota is a collection of bacteria and microorganisms found in the uterus that play an important role in fertility and embryo implantation success. Recent research suggests that the balance of this microbiota can increase the chances of fertility, while its disruption is associated with infertility and IVF failure.

The role of the uterine microbiota in fertility

1. Healthy bacterial composition

• The predominance of lactobacilli with an acidic environment prevents the growth of pathogenic bacteria.

• Facilitate embryo implantation and reduce endometrial inflammation.

2. Dysbiosis (microbial imbalance)

• An overgrowth of pathogenic bacteria can induce inflammation and decrease endometrial receptivity.

• It is associated with implantation failure and infertility.

3. Factors Influencing the Microbial Composition

• Age and Hormonal Changes

• Pharmacological Treatments and Antibiotics

• Lifestyle and Nutrition

Complementary and Alternative Therapies

1. Probiotics

• The use of probiotics (particularly Lactobacillus) to improve uterine microbial balance.

• It may increase the success rate of IVF.

2. Nutrition and Lifestyle

• A diet rich in fiber and nutrients: enhancing the immune system and microbial balance.

• Reducing the intake of sugar and unhealthy fats.

• Regular exercise to improve blood circulation and reduce stress.

3. Complementary and Alternative Medicine

• Acupuncture: Reducing stress and inflammation, and increasing uterine blood flow..

• Yoga and Meditation: Reducing chronic stress and improving hormonal balance..

• Natural Anti-Inflammatory Approaches: Such as consuming turmeric and omega-3.

Combining Complementary Therapies with Medical Approaches

• The use of probiotics alongside hormonal medications or after IVF.

• The positive impact of lifestyle interventions on oocyte and endometrial quality.

• Reducing the need for invasive medications by improving overall physical condition and uterine microbiota.

Conclusion

Identifying and modulating the uterine microbiota, along with the use of complementary and alternative therapies, can enhance fertility and embryo implantation success. These approaches are most effective when combined with conventional medical treatments.

Suggested References

• PMC: The role of endometrial microbiota in fertility and reproductive outcomes (2025)

• Journal of Assisted Reproduction and Genetics

Introduction

Endometriosis is an estrogen-dependent disease associated with chronic pelvic pain, severe dysmenorrhea, and infertility. Pharmacological treatment is considered one of the primary methods for disease management. In recent years, new medications and combination approaches have offered renewed hope for patients.

Objectives of Pharmacological Treatment

• Reducing pain and clinical symptoms

• Reducing or controlling endometriotic lesions

• Preventing disease recurrence after surgery

• Improving fertility chances (in some cases)

Common Medications in the Treatment of Endometriosis

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Such as ibuprofen and naproxen.

• Reducing menstrual and pelvic pain.

• Limitation: They do not have a direct effect on disease progression..

2. Hormonal Medications

• Combined Estrogen–Progestin Pills: Regulating the menstrual cycle and reducing symptoms..

• Progestins (such as Dienogest, Medroxyprogesterone): Inhibiting endometrial growth.

• Levonorgestrel-Releasing Intrauterine Device (IUD): Reducing bleeding and pain.

3. GnRH Agonists and Antagonists

• Reducing estrogen levels by inducing a hypoestrogenic (menopause-like) state.

• Rapid reduction of painful symptoms.

• Side Effects: Hot flashes, decreased bone density.

• Innovation: Using a low dose and combining with bone-protective hormones..

4. Aromatase Inhibitors

• Such as Letrozole and Anastrozole.

• Reducing estrogen production in peripheral tissues.

• Primarily in treatment-resistant cases.

Novel and Investigational Therapies

1. Targeted Anti-Inflammatory Drugs

• Cytokine Inhibitors (IL-1, TNF-α).

• Objective: Reducing local inflammation in endometrial tissue.

2. Combination Therapy

• Combining hormonal drugs with anti-inflammatory medications.

• Reducing drug doses and side effects.

3. Biologic Drugs

• Monoclonal antibodies targeting inflammatory pathways.

• Currently under investigation in clinical trials.

The Future of Pharmacological Treatment for Endometriosis

• Personalized Medicine: Drug selection based on the genome and individual patient characteristics..

• Next-generation oral GnRH drugs (such as Elagolix): With fewer side effects and high efficacy.

• Combining pharmacological treatment with surgery and complementary therapies To achieve the best outcomes.

Drug Comparison

Conclusion

Pharmacological treatment of endometriosis is moving towards novel, personalized, and combination approaches. Treatment selection should be based on disease severity, fertility desire, and drug tolerability.

Suggested References

• Human Reproduction Update (2024): Medical therapy for endometriosis: Current state and future perspectives

• The Lancet: Endometriosis and hormonal treatment strategies

Introduction

Surgery remains one of the primary treatments for endometriosis. In many patients, medications are insufficient to fully control symptoms, making surgery necessary for the removal of lesions and adhesions. Recent advancements in gynecological surgical techniques—particularly vNOTES and regenerative medicine approaches—have opened new horizons for patients.

Conventional Surgeries for Endometriosis

1. Conventional Laparoscopy

• Standard Method: Insertion of surgical instruments through small abdominal incisions..

• Advantages: Minimally invasive, rapid recovery, reduced bleeding.

• Disadvantages: Limited visibility in certain pelvic areas.

2. Laparotomy (Open Surgery)

• Primarily in complex cases or deep endometriosis.

• Longer recovery period, increased pain, and higher risk of adhesion recurrence.

Novel vNOTES Technique (Transvaginal Endoscopic Surgery)

Definition of vNOTES

• vNOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery): A minimally invasive approach performed through the vagina.

• In this method, there is no abdominal incision, and surgical instruments are introduced through the vagina.

Advantages of vNOTES

• No abdominal scars (better cosmetic outcome).

• Reduced postoperative pain.

• Faster hospital discharge.

• Better visualization of certain pelvic lesions.

Limitations

• Requires high surgical skill.

• Limited applicability in extensive lesions.

Regenerative Medicine in Endometriosis Surgery

1. Stem Cells

• Using mesenchymal stem cells to repair damaged pelvic tissues.

• Reducing adhesions and improving organ function.

2. Tissue Engineering

• Creating biological scaffolds for the reconstruction of uterine or ovarian tissue.

• Practical prospects for infertile women following extensive surgeries.

3. Targeted Drugs Post-Surgery

• Drugs that inhibit specific inflammatory pathways.

• Preventing endometriosis recurrence after surgery.

Surgery Comparison

The future of surgery in endometriosis

• Combining surgery and reconstructive medicine: Simultaneous use of waste removal and tissue repair.

• Advanced robotics: Greater precision in complex pelvic surgeries.

• Personalized surgeries: Choosing the method based on each patient’s condition.

Conclusion

vNOTES and regenerative medicine are a milestone in the surgical treatment of endometriosis. These techniques have brought new hope to patients by reducing complications and improving quality of life. The future of treatment will be a combination of technology, minimally invasive surgery, and tissue regeneration.

Suggested References

• Fertility and Sterility Journal (2025): Advances in Surgical Management of Endometriosis

• Journal of Minimally Invasive Gynecology

Introduction

Infertility treatment is one of the major challenges of modern medicine. Despite many advances in assisted reproductive technologies (ART), the success rate of these treatments remains lower than expected. In recent years, artificial intelligence (AI) has entered this field as a new tool and has been able to create a major revolution in embryo selection, pregnancy prediction, and treatment optimization.

The role of artificial intelligence in reproductive medicine

Using machine learning and deep learning, artificial intelligence can analyze huge amounts of data and find patterns that are not visible to doctors.

Main Applications of AI in Infertility Treatment:

1. Embryo Quality Assessment

   • Analysis of microscopic and time-lapse images.

   • Identification of morphological features associated with pregnancy success.

2. IVF Success Prediction

   • Using clinical data (age, ovarian reserve, medical history) along with embryonic data.

   • Developing predictive models for pregnancy chances.

3. Personalization of Treatment Protocols

   • Selecting the best medications and dosages for each patient.

   • Reducing the risk of side effects from hormonal treatments.

Benefits of Using Artificial Intelligence

1.Higher Accuracy in Embryo Selection

• Reducing human error in embryo assessment.

• Selecting the best embryo with a higher chance of implantation.

2. Increased Successful Pregnancy Rates

• Reducing the need to transfer multiple embryos.

• Reducing the risk of multiple pregnancies.

3. Cost Savings

• Reducing the number of unsuccessful IVF cycles.

• Optimizing the use of medications and resources.

Challenges and Limitations

Need for large and high-quality data

• Many clinics do not have sufficient or integrated data.

2. Ethical and Legal Issues

• Concerns regarding patient data privacy.

• The need for transparency in algorithms.

3. Lack of Global Standards

• Each clinic has its own methods, making comparisons difficult.

Innovations and Future Research

1. Combining Multiple Data Sources (Multi-Modal AI):

   • Combining images, videos, and medical data for more accurate predictions.

2. Explainable Deep Learning Models (Explainable AI):

   • Helping doctors understand the reasoning behind algorithm decisions.

3. Human-Machine Collaboration:

   • The doctor remains the final decision-maker but uses AI tools for optimal selection.

Conclusion

Artificial intelligence is becoming one of the key tools in infertility treatment. Despite the challenges, this technology can transform the future of reproductive medicine by improving accuracy in embryo selection, predicting IVF success, and personalizing treatments.

Suggested References

• Arxiv (2025): Multi-Modal Artificial Intelligence of Embryo Grading and Pregnancy Prediction in ART

• Journal of Assisted Reproduction and Genetics

Introduction

Endometriosis is one of the common gynecological disorders in women of reproductive age and can directly cause infertility. It is estimated that approximately 30 to 50 percent of women with this condition experience fertility problems. Understanding the mechanisms of this disease and finding effective treatments is of vital importance.

Causes of Infertility Due to Endometriosis

1.Ovulation Disorders

• Inflammation caused by endometriotic lesions can reduce egg quality.

• تغییر در محیط تخمدان باعث اختلال در بلوغ فولیکول‌ها می‌شود.

۲. چسبندگی‌های لگنی و لوله‌های فالوپ

• چسبندگی‌ها مانع حرکت طبیعی تخمک می‌شوند.

• انسداد لوله‌های فالوپ یکی از شایع‌ترین پیامدهاست.

۳. کاهش پذیرش اندومتر

• اندومتر در بیماران آندومتریوز کمتر پذیرای جنین است.

• افزایش سایتوکاین‌های التهابی مانع لانه‌گزینی می‌شود.

۴. اختلالات ایمنی

• تغییر در سلول‌های NK و T می‌تواند باروری را مختل کند.

رویکردهای درمانی

۱. Pharmacological Treatment

• استفاده از داروهای هورمونی (GnRH agonists, پروژستین‌ها).

• این داروها علائم را کنترل می‌کنند اما باروری را بهبود نمی‌بخشند.

2. جراحی

• لاپاروسکوپی: برای برداشتن کیست‌ها و ضایعات.

• مزایا: افزایش شانس بارداری طبیعی.

• معایب: احتمال کاهش ذخیره تخمدان.

۳. فناوری‌های کمک‌باروری (ART)

• IVF: موثرترین روش برای آندومتریوز شدید.

• IUI: برای مراحل خفیف یا بعد از جراحی.

چشم‌اندازهای نوین

• پزشکی بازساختی: استفاده از سلول‌های بنیادی برای ترمیم اندومتر.

• داروهای هدفمند: مهارکننده‌های مسیرهای التهابی خاص.

• رویکرد فردمحور: انتخاب درمان بر اساس شرایط فردی بیمار.

Conclusion

آندومتریوز می‌تواند اثرات عمیقی بر باروری داشته باشد. درمان مؤثر باید بر اساس شدت بیماری، سن بیمار و برنامه باروری او انتخاب شود.

Suggested References

• Springer: Endometriosis and infertility: pathophysiology, treatment strategies (2025)

• Human Reproduction Journal