Endometriosis and fertility: what the evidence says

Many women with endometriosis conceive without any help. That is worth stating first, because the internet suggests otherwise within about thirty seconds of searching.

In short: Endometriosis can reduce fertility through inflammation, adhesions and ovarian involvement, but a large proportion of women with the condition conceive naturally. Surgery may improve conception rates in some cases, and IVF is effective where it does not.

How it can affect conception

• Adhesions and scarring can distort pelvic anatomy and affect the fallopian tubes
• Ovarian endometriomas can reduce ovarian reserve, and so can surgery to remove them
• Inflammation in the pelvic environment may affect egg quality, fertilisation and implantation
• Pain during sex reduces frequency, which is a practical factor rarely mentioned

Severity of pain does not predict fertility impact. Women with minimal pain can have significant disease, and the reverse is equally true.

Does surgery help?

For some women, laparoscopic excision or ablation improves the chance of natural conception, particularly where disease is limited. For ovarian endometriomas the decision is more finely balanced, because surgery itself can reduce ovarian reserve. This is a conversation for a specialist who can weigh your age, reserve and disease pattern together.

IVF

IVF is effective in endometriosis. Outcomes are somewhat lower on average than in women without the condition, and vary with age and ovarian reserve. Some protocols use a period of hormonal suppression before a cycle. NHS eligibility criteria vary by area, so check your local policy early.

Ovarian reserve testing

AMH testing gives an indication of reserve, particularly relevant where endometriomas are present or surgery is planned. It is not a fertility prediction on its own.

When to seek help

• After twelve months of trying, or six months if you are over 35
• Sooner if you have known endometriomas, previous pelvic surgery, or very painful periods with bowel symptoms
• Sooner if your cycles are irregular

Raising it early is not premature. Time is the variable you cannot recover.

While you are trying

Hormonal treatments that control endometriosis pain also prevent pregnancy, which puts many women in a difficult position. Discuss the plan with your clinician rather than stopping treatment unilaterally, and ask what pain management is available during that window.

Common questions

Does endometriosis always cause infertility? No. Many women conceive without intervention.

Should I freeze my eggs? It is a reasonable question where ovarian reserve is reduced or surgery is planned. It is a specialist conversation.

Will pregnancy improve my endometriosis? Symptoms may ease during pregnancy but generally return afterwards.

Read the full endometriosis guide or the cycle and fertility hub.