Endometriosis can affect fertility for some people, but not everyone with endometriosis will have difficulty getting pregnant.
Some people first learn they may have endometriosis during fertility investigations. Others have confirmed endometriosis and become pregnant without difficulty. Both experiences are possible. Fertility advice should be individual. It should consider your symptoms, age, fertility goals, ovarian reserve, endometriomas, previous surgery, partner or sperm factors, how long you have been trying, and what matters most to you.
How endometriosis may affect fertility
Endometriosis may affect fertility in different ways. Possible factors include:
- inflammation in the pelvis
- adhesions or scar tissue affecting pelvic anatomy
- endometriomas involving the ovaries
- changes around the ovaries or fallopian tubes
- reduced ovarian reserve in some people
- pain during or after sex reducing opportunities to conceive
- deep endometriosis or organ involvement
- previous ovarian surgery
- other fertility factors not caused by endometriosis
Fertility can also be affected by age, ovulation, sperm quality, fallopian tube function, other health conditions and timing. Endometriosis may be one part of the picture, not always the only factor.
Endometriomas and ovarian reserve
Endometriomas are ovarian cysts linked with endometriosis. They may be relevant to fertility discussions because they involve the ovary and may affect ovarian tissue or ovarian reserve for some people. Surgery for endometriomas can sometimes help symptoms or fertility planning, but it can also affect ovarian reserve, so decisions need careful specialist advice. Ask how the size, location and number of endometriomas may affect your options, and whether ovarian reserve testing is appropriate.
Surgery and fertility
Surgery may improve the chance of spontaneous pregnancy in some situations, but it is not always the right first step for everyone. Medical governing bodies often recommend discussing the benefits and risks of laparoscopic surgery for people with deep endometriosis who are trying to conceive, including possible effects on pregnancy chances, possible fertility impact if complications arise, alternatives to surgery and other fertility factors. Before surgery, ask how the plan may affect fertility, ovaries, tubes, endometriomas and future treatment options.
Assisted fertility treatment
Some people may be offered fertility treatment, depending on their situation. Options may include:
- ovulation induction in selected cases
- intrauterine insemination, known as IUI
- in vitro fertilisation, known as IVF
- fertility preservation discussion in selected circumstances
The right option depends on age, ovarian reserve, sperm factors, tubes, previous treatment, endometriosis severity, symptoms, local guidance and personal goals.
Hormonal treatment and trying to conceive
Hormonal treatment may help pain or bleeding symptoms for some people with endometriosis, but it prevents pregnancy while being used. If you are actively trying to conceive, ask whether hormonal treatment is appropriate. Most medical governing bodied will specifically say hormonal treatment should not be offered alone or with surgery to people with endometriosis who are trying to conceive, because it does not improve spontaneous pregnancy rates.
When to ask for fertility advice
Ask early if fertility matters to you now or may matter in the future. This is especially important if you have:
- been trying to conceive without success
- known or suspected endometriomas
- previous ovarian surgery
- one ovary
- deep endometriosis
- severe pain affecting sex
- irregular cycles
- age-related concerns
- known sperm or partner fertility factors
- concerns about ovarian reserve
- upcoming surgery involving the ovaries
You do not need to wait until you are in crisis to ask about fertility.
Questions to ask
You may want to ask:
- Could endometriosis affect my fertility?
- Should I have fertility tests?
- Should ovarian reserve be checked?
- Could treatment affect ovarian reserve?
- Could surgery affect my ovaries or fertility?
- Should I see a fertility specialist?
- Are my fallopian tubes likely to be affected?
- Are sperm or partner factors being assessed too?
- Should I consider IVF, IUI or other fertility treatment?
- What are my options if I want pregnancy now?
- What are my options if I may want pregnancy later?
Prepare before you speak with a healthcare professional
Use our Prepare for Appointment Tool to organise your symptoms, questions, fertility priorities, previous treatments, surgery history, scan results and concerns before your appointment. Try to record how long you have been trying to conceive if relevant, cycle pattern, pain with sex, previous pregnancies or losses, endometrioma history, surgery history and any fertility tests already done. You do not need a perfect diary. A clear summary can help the conversation feel more focused.
Finding the right type of care
Use the Endometriosis Care Directory to explore endometriosis-related care providers, including fertility specialists, endometriosis specialists and multidisciplinary clinics. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.
Final reminder
Endometriosis can affect fertility for some people, but it does not mean pregnancy is impossible. You deserve clear, individual advice that considers your symptoms, age, ovarian reserve, endometriomas, previous surgery, fertility goals and other fertility factors. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.