Although numerous anti-angiogenic compounds have been tested, evidence remains fragmented, and no comparative framework guides the selection of agents compatible with fertility preservation.<h4>Objective</h4>To identify and rank vascular-targeted pharmacotherapies that most effectively regress endometriotic lesions and could be prioritised for fertility-sparing clinical translation.<h4>Methods</h4>We conducted a systematic review and frequentist network meta-analysis (PROSPERO CRD420251082905) of controlled studies evaluating VEGF-directed agents in endometriosis. This evidence concerns the gene VEGFA and endometriosis.