Background: Despite significant advances in the management of endometriosis, surgical treatment of endometriomas, including cyst enucleation using various energy modalities, inevitably exerts a negative impact on ovarian reserve (OR). Even minimally invasive and organ-preserving procedures such as cystectomy are associated with the risk of deep ovarian tissue damage and a reduction in primordial and antral follicle count, thereby compromising reproductive potential.

Objective: To evaluate the role of ovarian PRO-therapy using plasma rich in growth factors (PRGF) as a regenerative medicine approach aimed at restoring ovarian function, preserving ovarian reserve, and improving reproductive outcomes in women with endometriosis-associated infertility.

Materials and Methods: PRGF therapy involves the local administration of autologous plasma enriched with growth factors derived from the patient’s own blood. PRGF was administered:

• intraovarianly

The therapy was applied in infertile women with reduced ovarian reserve and within preconception care protocols, both before and after surgical treatment of endometriosis.

Results: PRGF therapy demonstrated a stimulatory effect on ovarian tissue regeneration, enhancement of tissue trophism, and activation of folliculogenesis. Improvement in the morphofunctional status of both the generative and endocrine components of the ovaries was observed. A significantly higher pregnancy rate was noted in patients with a history of a single cystectomy compared to those with multiple surgical interventions, highlighting the critical importance of ovarian reserve preservation. Local PRGF administration was also associated with improved endometrial proliferation and increased endometrial receptivity, contributing to better implantation potential in infertile patients.

Discussion: The most effective strategy for managing endometriosis-related infertility appears to be a combined approach that includes complete surgical excision of endometriotic lesions followed by conservative and regenerative therapies. PRGF therapy represents a promising adjunctive modality, potentially reducing the risk of premature ovarian insufficiency and enhancing reproductive prognosis.

Clinical Implications: Assessment of ovarian reserve parameters during preconception counseling, both before and after surgical intervention, has significant prognostic value. This approach allows clinicians to individualize patient management by either adopting expectant management in women with favorable prognosis or promptly proceeding to assisted reproductive technologies (ART) in cases of poor ovarian reserve.

Conclusions: Ovarian PRGF therapy is a safe and promising regenerative technique. Although this innovative approach is still undergoing further clinical refinement, current evidence supports its effectiveness in ovarian stimulation, restoration of ovarian reserve, and management of premature ovarian insufficiency. Future advancements are expected to further improve clinical outcomes.

To be Updated