Figure 2. Schematic representation of the possible mechanisms by which endometriosis affects reproductive outcomes in assisted reproductive technology (ART) at multiple levels. The upper panel depicts alterations in ovarian, oocyte, and endometrial quality, including hormonal imbalances, oxidative stress, apoptosis, mitochondrial and spindle defects, and transcriptional dysregulation. The lower panel illustrates the downstream consequences on ovarian reserve, embryo development, and clinical outcomes, such as reduced numbers of mature oocytes and embryos and compromised embryo developmental and implantation rates.