Natalia C. Llarena, MD, FACOG, on clinical diagnosis and early fertility preservation in endometriosis

The path to an endometriosis diagnosis has historically been characterized by significant delays, often stemming from the traditional reliance on surgical confirmation. Natalia C. Llarena, MD, FACOG, Reproductive endocrinologist, ob-gyn, HRC Fertility, Pasadena, California, discussed how shifting toward clinical diagnosis and early reproductive consultation can improve patient outcomes and preserve future fertility.

Prioritizing clinical diagnosis over surgical delay

Several factors contribute to the protracted timeline for diagnosis, including the overlap of symptoms with gastrointestinal and genitourinary conditions. Llarena noted that while laparoscopy remains the gold standard for definitive diagnosis, the requirement of a surgical procedure often acts as a barrier to care.

“It's not that laparoscopy is no longer part of the diagnosis,” Llarena explained. “This is still critical and often necessary to make a definitive diagnosis, but it does not mean that patients need to wait for this in order to initiate treatment.”

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She highlighted recent guidance from the American College of Obstetricians & Gynecologists (ACOG) prioritizing clinical diagnosis as a means to get patients to treatment more quickly. This approach relies on shared decision-making, allowing patients to choose between immediate surgical intervention or empiric treatment to address pain and symptoms.¹

While noninvasive biomarkers are a subject of significant interest, with preclinical studies having demonstrated potential,² Llarena cautioned that they are not yet "ready for prime time," as their diagnostic accuracy does not currently exceed the combination of physical examination and imaging.

Early intervention and fertility preservation

We know that anytime we are removing an endometrioma, there is an impact to the ovarian reserve,” Llarena stated. This cumulative damage is often seen in patients who reach their late 30s or early 40s after years of disease progression and multiple procedures.

To mitigate these risks, Llarena advocates for early consultation with a reproductive endocrinologist. This is especially critical for patients who may want children in the future but require surgery to manage their current symptoms. By discussing fertility preservation as young as possible—and ideally before undergoing pelvic surgery—patients can better understand their options. As Llarena concluded, because these patients are more likely to eventually require in vitro fertilization, early proactive planning is essential to protect their reproductive potential.

References:

1. ACOG publishes new endometriosis clinical guidance, aiming to shorten time to diagnosis and improve access to care. American College of Obstetricians & Gynecologists. Published February 20, 2026. Accessed April 8, 2026. https://www.acog.org/news/news-releases/2026/02/acog-publishes-new-endometriosis-clinical-guidance-aiming-shorten-time-diagnosis-improve-access-care
2. Fitch J. Alla Vash-Margita, MD, FACOG, discusses microRNAs as earlier detection biomarkers for endometriosis. Contemporary OB/GYN. Published March 24, 2026. Accessed April 8, 2026. https://www.contemporaryobgyn.net/view/alla-vash-margita-md-facog-discusses-micrornas-as-earlier-detection-biomarkers-for-endometriosis