Endometriosis (EMs), a common gynecological disorder among women of reproductive age, severely compromises female fertility by inducing inflammatory microenvironment alterations, impairing ovarian function, and disrupting endometrial receptivity. Conventional pharmacological therapies primarily focus on symptom alleviation but lack specificity in fertility preservation, with potential long-term ovarian suppression. Recent advances in targeted drug development, informed by the elucidation of EMs pathogenesis, have yielded novel strategies for fertility protection. This article comprehensively reviews the therapeutic limitations of traditional agents in fertility preservation and discusses the advancements in emerging therapeutics, including angiogenesis inhibitors, immunomodulators, antioxidants, and innovative treatment modalities. By integrating mechanistic insights with clinical applications, this review aims to optimize clinical management strategies and safeguard fertility outcomes for EMs patients with reproductive aspirations.

子宫内膜异位症（EMs）是育龄期妇女常见的一种疾病，其引起的炎症微环境改变、卵巢功能受损及内膜容受性改变严重威胁女性的生育能力。传统药物治疗以缓解症状为主，但对生育力保护缺乏针对性，且长期使用可能抑制卵巢功能。近年来，针对EMs病理机制的新型靶向药物研发取得显著进展，为生育力保护提供了新策略。本文总结了传统药物对生育力保护的治疗策略及新型药物如血管生成抑制剂、免疫调节剂、抗氧化剂及新型治疗方式在EMs生育力保护方面的进展，期待优化临床治疗策略，为有生育要求的内异症患者保驾护航。