Identification and prevention of maternal factors associated with the risk of obstetric complications is a relevant problem of women's reproductive health. To achieve favorable obstetric and perinatal outcomes, it is extremely important to clearly understand the essence of gynecological problems that pose a threat to a woman's reproductive health at the stage of preconception care.
Many gynecological diseases can cause serious reproductive impairments: in particular, infertility, miscarriage, preeclampsia and other obstetric complications.
The most common gynecological diseases that increase the risk of reproductive failures include endometriosis, adenomyosis, endometrial pathology, polycystic ovary syndrome, uterine fibroids, cervical intraepithelial neoplasia, etc.
Infertility in endometriosis is caused by a variety of etiopathogenic factors that reduce fertility both individually and in combination.
To increase the chances of pregnancy, women with AFS/ASRM stage I/II endometriosis should undergo laparoscopic surgery (excision or ablation of endometrioid lesions) with concomitant adhesiolysis.
According to the Cochrane review data, laparoscopic treatment of non-severe forms of endometriosis leads to an increase in the frequency of pregnancy onset and live birth rates.
However, surgical treatment of ovarian endometrioma deserves special attention due to the possible negative impact on fertility. It was found that women with ovarian endometrioma initially have a reduced ovarian reserve (decreased level of anti-mullerian hormone) compared to women without endometrioma. Surgical excision of endometrioma further reduces AMH level, but after about 6 months, it returns to its original value (below normal).