Therapeutic Advances in Endometriosis-Associated Infertility: From Conventional Hormonal Therapy To Linzagolix

Abstract

Endometriosis is a chronic estrogen-dependent disorder characterized by endometrial-like tissue outside the uterine cavity and is strongly associated with pelvic pain, inflammation, adhesions, and impaired fertility. Endometriosis-associated infertility is multifactorial and may involve pelvic anatomical distortion, tubal dysfunction, impaired ovulation and fertilization, ovarian damage, reduced ovarian reserve, altered oocyte quality, and impaired embryo implantation. This review summarizes the clinical features, epidemiology, risk factors, pathogenesis, diagnostic methods, and therapeutic approaches associated with endometriosis-related infertility. Conventional management includes pain management, hormonal therapy, conservative surgery, lifestyle modification, and assisted reproductive technologies such as intrauterine insemination and in vitro fertilization. Combined ethinyl estradiol and levonorgestrel suppress ovulation and reduce estrogenic stimulation of endometriotic lesions, contributing to control of pain and menstrual symptoms. Linzagolix is an orally administered, non-peptide GnRH receptor antagonist that produces rapid and dose-dependent suppression of ovarian estrogen production. Clinical evidence described in the source document indicates reductions in dysmenorrhea, non-menstrual pelvic pain, and heavy menstrual bleeding, while add-back therapy may reduce hypoestrogenic effects during extended treatment. Management of endometriosis-associated infertility requires a patient-centered approach considering age, disease severity, ovarian function, and reproductive goals.