Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause painful periods, pelvic pain and discomfort during sex. For some people, it can also affect fertility.
Being diagnosed with endometriosis does not mean that pregnancy is impossible. Many people with the condition conceive naturally, while others may need help from a fertility specialist.
Understanding how endometriosis affects the reproductive system can help you have informed discussions about your options.
1. What Is Endometriosis?
Endometriosis occurs when tissue similar to the uterine lining grows in places such as the ovaries, fallopian tubes or other areas of the pelvis.
This tissue can respond to hormonal changes during the menstrual cycle and may contribute to inflammation, pain, scar tissue or adhesions.
Symptoms vary widely. Some people experience significant pain, while others have few noticeable symptoms.
2. How Can Endometriosis Affect Fertility?
Endometriosis may affect fertility in several ways:
Inflammation: Changes in the pelvic environment may interfere with reproductive processes.
Scar tissue and adhesions: These can affect the position or movement of reproductive organs.
Fallopian tube function: Disease or adhesions around the tubes may interfere with the movement of an egg.
Ovarian endometriomas: Endometriosis-related cysts on the ovaries may affect ovarian function. Surgery to treat them can also reduce ovarian reserve in some cases.
Other fertility factors: Some people have additional causes of infertility alongside endometriosis.
The effect depends on the location and extent of the disease and the person's overall reproductive health. The severity of pain does not necessarily indicate how much fertility is affected.
3. What Are the Symptoms?
Common symptoms may include:
Painful menstrual periods.
Persistent pelvic or lower abdominal pain.
Pain during or after sex.
Pain when passing stool or urine, particularly around menstruation.
Difficulty becoming pregnant.
These symptoms can have other causes, so they do not confirm endometriosis on their own. Some people with endometriosis have no obvious symptoms.
If pelvic pain affects your daily life or you have concerns about fertility, seek medical advice.
4. How Is Endometriosis Diagnosed?
A healthcare professional may review your symptoms and medical history, perform an examination when appropriate, and recommend imaging such as an ultrasound.
Ultrasound can identify some ovarian endometriomas and other pelvic abnormalities, but a normal scan does not rule out all endometriosis.
In selected situations, further assessment or surgery may be considered. The appropriate approach depends on symptoms, examination findings, fertility goals and previous treatment.
5. Can You Get Pregnant Naturally With Endometriosis?
Yes. Many people with endometriosis conceive naturally. Others may take longer or need fertility treatment.
Your chances depend on factors such as age, ovarian reserve, the condition of your fallopian tubes, how the disease affects your reproductive organs and your partner's sperm health.
If you have endometriosis and are trying to conceive, a specialist can help determine whether it is reasonable to continue trying naturally or whether an evaluation or treatment would be beneficial.
6. What Treatment Options May Be Considered?
Treatment depends on whether your main goal is pain relief, pregnancy, or both.
Pain management: Medication and other approaches may help manage symptoms. Hormonal treatments used to suppress endometriosis generally prevent pregnancy while being used, so they are not fertility treatments for someone actively trying to conceive.
Surgery: In selected cases, surgery may be considered to treat endometriosis or address anatomy affected by the disease. However, ovarian surgery can reduce ovarian reserve, so potential benefits and risks should be discussed carefully.
Fertility treatment: Depending on your assessment, options may include surgery in selected cases, IUI for certain patients, or IVF. The best choice depends on the individual situation rather than the diagnosis alone.
No single treatment is right for everyone, and treatment cannot guarantee pregnancy.
7. When Should You See a Fertility Specialist?
Consider seeking advice if you have known or suspected endometriosis and are planning a pregnancy, particularly if you have irregular periods, previous ovarian surgery, known tubal problems or persistent pelvic pain.
General guidance recommends evaluation after 12 months of trying for those under 35 and after 6 months at age 35 or older. People over 40 or with known fertility-related conditions may benefit from earlier assessment.
Frequently Asked Questions
Does endometriosis always cause infertility?
No. Many people with endometriosis conceive naturally. Its effect on fertility varies.
Can IVF help with endometriosis-related infertility?
IVF may help some people, depending on their age, ovarian reserve, tubal health and other factors. A specialist can discuss likely benefits and limitations.
Should endometriosis always be removed before IVF?
No. Surgery is not automatically necessary before IVF and may carry risks, including reduced ovarian reserve when ovarian endometriomas are operated on. Decisions should be individualised.
Can I have endometriosis without severe pain?
Yes. Symptoms vary, and some people have few or no noticeable symptoms.
The Bottom Line
Endometriosis can affect fertility, but it does not mean pregnancy is impossible. If you have symptoms or are finding it difficult to conceive, an appropriate assessment can help you understand your options.
Related articles on Dream Baby
Blocked Fallopian Tubes and Fertility
Medical information disclaimer
This article is for general educational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. It has not been medically reviewed by a Dream Baby doctor. Please consult a qualified healthcare professional for advice about your circumstances.
References
1. European Society of Human Reproduction and Embryology (ESHRE). Endometriosis Guideline. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
2. American Society for Reproductive Medicine (ASRM). Fertility Evaluation of Infertile Women: A Committee Opinion. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/