Endometriosis and Fertility: Can You Get Pregnant?

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Many Women with Endometriosis Conceive

While endometriosis can make conception more challenging, the majority of women with mild to moderate endometriosis can conceive naturally or with treatment. Even severe cases often have options.

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus—on the ovaries, fallopian tubes, and pelvic surfaces. It's a leading cause of infertility, but the connection between endometriosis and fertility is complicated, and a diagnosis doesn't mean you can't have children.

10%

of women have endometriosis

30-50%

of infertile women have it

60-70%

eventually conceive

How Endometriosis Affects Fertility

Endometriosis can impact fertility through multiple mechanisms—and often, it's a combination of factors:

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Anatomical Distortion

Scar tissue (adhesions) can distort pelvic anatomy, blocking fallopian tubes or affecting how the ovary releases eggs.

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Ovarian Function

Endometriomas (ovarian cysts from endometriosis) can damage ovarian tissue and reduce egg reserve and quality.

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Inflammation

The chronic inflammatory environment may impair egg quality, sperm function, fertilization, and embryo development.

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Implantation Issues

Endometriosis may affect the uterine lining's receptivity to embryo implantation, though this is still being studied.

Importantly, the severity of symptoms doesn't always correlate with fertility impact. Some women with severe pain have minimal fertility issues, while some with "silent" endometriosis (no symptoms) discover it only when investigating infertility.

Stages of Endometriosis

Endometriosis is classified into four stages based on the extent and location of tissue, adhesions, and ovarian involvement:

IStage

Minimal

Small, isolated implants with no significant scarring. Often found incidentally during surgery for other reasons.

Fertility: Usually minimally affected. Most conceive naturally.

IIStage

Mild

More implants, deeper involvement, minimal adhesions. Still relatively limited disease.

Fertility: Moderately affected. Many conceive naturally; some need assistance.

IIIStage

Moderate

Many deep implants, small cysts on ovaries (endometriomas), significant adhesions affecting the tubes or ovaries.

Fertility: Often significantly affected. Treatment usually needed.

IVStage

Severe

Large ovarian cysts, extensive adhesions, possible involvement of bowel, bladder, or other organs. The pelvis may be "frozen" with scar tissue.

Fertility: Usually significantly impaired. IVF often needed.

💡 Stage Doesn't Perfectly Predict Fertility

The staging system was designed for surgical planning, not fertility prediction. Location matters as much as amount—stage I endometriosis in the wrong spot (like blocking a tube) can cause more fertility problems than more extensive disease elsewhere. Your fertility specialist can help you understand your specific situation.

Getting Diagnosed

Endometriosis can only be definitively diagnosed through surgery (laparoscopy), but doctors often suspect it based on:

Symptoms: Painful periods, pain during sex, chronic pelvic pain, painful bowel movements or urination during periods
Ultrasound: Can detect endometriomas (ovarian cysts) but not superficial implants
MRI: May show deep infiltrating endometriosis
Physical exam: May reveal nodules or tenderness

Many fertility specialists will treat "suspected" endometriosis based on symptoms and imaging without requiring surgical confirmation, especially if the goal is pregnancy rather than pain management.

Treatment Options for Fertility

The approach depends on your age, stage of endometriosis, symptom severity, and how long you've been trying:

The Treatment Pathway

Expectant Management (Trying Naturally)

For mild endometriosis and younger women: try naturally for 6-12 months with timed intercourse. Monthly fecundity is lower (~2-10% vs. ~20% in women without endometriosis) but conception is possible.

Surgery (Laparoscopy)

Removing endometriosis surgically can improve fertility, especially for stage I-II. Post-surgery, many women experience improved fertility for a "window" of 6-12 months. Surgery for severe disease is more complex and should be done by specialists.

Ovulation Induction + IUI

Medications like letrozole or Clomid with intrauterine insemination (IUI) may help mild cases. Success rates are modest but it's less invasive than IVF. Typically 3-4 cycles are attempted.

IVF

Often recommended for moderate-severe endometriosis, tubal blockage, or after failed lower-level treatments. IVF bypasses many of the anatomical obstacles. Success rates are generally good, though may be slightly lower than for other indications.

"The 'right' treatment depends on your individual situation. Age is a critical factor—the older you are, the more quickly you should move to more effective treatments like IVF."

Should You Have Surgery Before TTC?

This is one of the most debated questions in reproductive medicine. The answer depends on several factors:

Surgery may help if:

You have significant pain that needs treatment anyway
You have stage I-II endometriosis (surgery clearly improves fertility at these stages)
You're young (under 35) with time to try naturally after surgery
Tubes are blocked or distorted anatomy needs correction

Surgery may not be best if:

You have large endometriomas—surgery can damage healthy ovarian tissue and reduce egg reserve
You're older (35+) where time matters more
You have severe, deeply infiltrating disease requiring complex surgery
You're planning IVF anyway (it bypasses the tubes)

⚠️ Endometriomas and Ovarian Reserve: Surgery on ovarian endometriomas can damage surrounding healthy ovarian tissue, potentially reducing egg reserve. For women planning IVF, some specialists recommend proceeding directly to IVF rather than surgical removal, unless the cyst is very large (>4cm) or causing other problems.

Medical Treatments: A Note

Hormonal treatments for endometriosis (birth control pills, GnRH agonists, progestins) manage symptoms and suppress disease but don't improve fertility. In fact, they prevent pregnancy during use.

There's no evidence that "suppressing" endometriosis with hormones before trying to conceive improves pregnancy rates. Time spent on suppression is time not trying.

However, short courses of GnRH agonists before IVF may improve outcomes in some cases—this is a specific protocol decision your RE can discuss.

Supporting Your Fertility with Endometriosis

While there's no supplement that "cures" endometriosis, supporting overall fertility health is worthwhile:

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Antioxidant Support

Qunol CoQ10 200mg

CoQ10 supports mitochondrial function and egg quality. Some research suggests antioxidants may help counter the inflammatory environment of endometriosis.

Check Price →

Anti-inflammatory diet: While not proven to improve fertility specifically, reducing inflammatory foods (processed foods, sugar, excess red meat) and increasing omega-3s, fruits, and vegetables may support overall health.

Omega-3 fatty acids: Some studies suggest omega-3s may help reduce endometriosis-related inflammation. Worth considering as part of general fertility support.

Vitamin D: Deficiency is common and associated with worse endometriosis. Test and supplement if low.

Understand Your Options

Our quiz can help point you in the right direction based on your situation.

Take the Fertility Quiz →

What About Egg Freezing?

If you have endometriosis and aren't ready to try for pregnancy, egg freezing deserves consideration. Endometriosis can be progressive—it may worsen over time, and surgical treatment of endometriomas reduces ovarian reserve. Freezing eggs while you're younger preserves options.

This is especially worth discussing if:

You have endometriomas that may eventually need surgery
Your AMH (ovarian reserve marker) is already on the lower end
You're in your early-to-mid 30s and not planning to try soon

The Bottom Line

Endometriosis is challenging, but it's not a fertility death sentence:

Most women with endometriosis can conceive—naturally or with treatment
Stage matters but isn't everything—location and individual factors are important too
Don't delay seeking help—especially if you're over 35 or have been trying 6+ months
Surgery can help but isn't always needed—discuss with a specialist who understands your goals
IVF is very effective for endometriosis-related infertility
Endometriosis doesn't affect pregnancy itself—once pregnant, outcomes are generally normal

Work with a reproductive endocrinologist who understands endometriosis. The right approach for you depends on your age, the extent of disease, your pain levels, and how long you've been trying.

Frequently Asked Questions

Does pregnancy cure endometriosis?

No, but pregnancy suppresses endometriosis due to high progesterone levels. Many women experience symptom relief during pregnancy and breastfeeding. However, endometriosis typically returns afterward. Pregnancy doesn't "cure" the disease, but it does provide a break from symptoms.

Will endometriosis affect my pregnancy once I conceive?

Generally, no. Once pregnant, most women with endometriosis have normal pregnancies. There may be slightly elevated risks of preterm birth and some complications, but for most women, pregnancy proceeds normally. Your endometriosis symptoms will likely improve during pregnancy.

I have mild endometriosis—should I still see a specialist?

If you've been trying for 6-12 months without success, yes. A reproductive endocrinologist can help determine if other factors are involved and optimize your approach. Even mild endometriosis can reduce monthly conception chances, so you may benefit from timed intercourse guidance or simple interventions.

Can endometriosis come back after surgery?

Yes, recurrence rates are significant—about 20-40% within 5 years. This is why timing conception after surgery matters. The months immediately following surgery often represent the best fertility window. If you're not ready to try immediately after surgery, discuss fertility preservation or hormonal suppression with your doctor.

How do I find an endometriosis specialist?

For fertility, see a reproductive endocrinologist (RE). For complex surgical cases, look for a gynecologic surgeon who specializes in endometriosis—often those who do minimally invasive/advanced laparoscopy. Major academic medical centers often have dedicated endometriosis programs. Don't hesitate to seek a second opinion for severe cases.