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However, a Cochrane systematic review encompassing five randomized controlled trials (415 women) found insufficient very low-quality evidence to support its effectiveness in improving clinical pregnancy rate (RR 1.38, 95% CI 0.91 to 2.10), live birth rate, overall pain, miscarriage rate (Peto OR 1.99, 95% CI 0.20 to 19.37), or endometriosis recurrence (RR 0.84, 95% CI 0.30 to 2.36), highlighting the need for higher-quality trials ( Novel devices for pain and symptom management offer ultralow-invasive options that may preserve ovulatory function, a critical consideration for reproductive-aged women

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Rationale: Tesamorelin is FDA-approved for reducing visceral fat Ipamorelin adds complementary GH stimulation Combined effect on body composition Note: Tesamorelin is more expensive and prescription-only in many contexts

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