Endometriosis is a chronic condition that negatively affects women’s quality of life and reproductive function. This article examines modern approaches to optimizing surgical treatment, particularly the choice of operative strategy depending on the form and stage of endometriosis, the application of laparoscopy, and adjuvant pharmacological therapy. The aim is to investigate the effectiveness of different surgical strategies for genital endometriosis in reproductive-aged women and to develop an optimized treatment model considering fertility prognosis. The study included 90 women of reproductive age diagnosed with endometriosis, who were divided into the following groups: Group I (n=90) — patients who underwent laparoscopic removal of endometriotic lesions without ovarian resection, followed by dienogest therapy for 6 months; Group II (n=90) — women who underwent laparoscopic resection of endometriomas and were subsequently enrolled in ART programs (IVF/ICSI); Group III (n=90) — patients treated with combined therapy, including laparotomy and GnRH antagonist administration at the preoperative stage. A comprehensive clinical, instrumental, microbiological, and immunological examination was conducted. The analysis of results demonstrated that a personalized surgical approach, combined with adjuvant hormone therapy or inclusion in ART programs, ensures higher treatment efficacy in terms of pain reduction, preservation of ovarian reserve, and recurrence prevention. This approach significantly improves reproductive outcomes.