| Table 2. Phenotype-based pragmatic management before and during IVF/ICSI | |
| Clinical scenario | Recommended approach |
|---|---|
| Peritoneal disease | Standard IVF/ICSI |
| Endometrioma (no symptoms) | Avoid routine surgery before IVF unless clinically indicated |
| Endometrioma + pain | Consider selective surgery |
| Prior ovarian surgery | Maximize stimulation, avoid repeat surgery |
| Adenomyosis | Freeze-all may be considered in selected cases |
| Difficult follicle access | Surgery only if necessary |
| Low ovarian reserve | Cumulative strategy (multiple cycles) |