Endometriosis and Fertility: Can You Still Get Pregnant?

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Understanding how endometriosis can affect conception, ovarian reserve and your journey towards having a baby.

For many women trying to conceive, an endometriosis diagnosis brings mixed emotions. There may be relief at finally understanding longstanding pain, alongside fear about what the diagnosis means for becoming a mother.

Questions such as “Will I ever get pregnant?”, “Could this explain why I haven't conceived?” and “Will I need IVF?” can feel difficult to carry.

Endometriosis can affect fertility, but it does not automatically mean you cannot get pregnant.

The right approach depends on your individual circumstances. There is no single answer that applies to everyone.

What is endometriosis?

Endometriosis is a chronic condition in which tissue similar to the lining of the womb grows outside the uterus. Lesions can develop around the ovaries, fallopian tubes, pelvic lining and other structures.

The condition can cause inflammation, scarring and adhesions, bands of tissue that may cause pelvic organs to stick together.

Symptoms may include:

• Painful periods that interfere with everyday life.
• Persistent pelvic or lower abdominal pain.
• Pain during or after sex.
• Pain when passing urine or opening the bowels, particularly around menstruation.
• Difficulty getting pregnant.

Some women have severe symptoms; others have few or none. The severity of pain does not reliably indicate how extensive the condition is or how much it may affect fertility.

How can endometriosis affect fertility?

Its effects depend on where lesions are located, whether the ovaries or fallopian tubes are affected and whether other fertility factors are present.

Inflammation and the pelvic environment

Endometriosis is associated with pelvic inflammation. Changes in this environment may affect reproductive processes involving sperm, eggs and surrounding tissues. The exact contribution varies between individuals and remains an area of research.

Fallopian tubes and adhesions

The fallopian tubes help bring egg and sperm together. Adhesions may distort pelvic anatomy or interfere with tubal function. If a tube is blocked or significantly impaired, natural conception may become more difficult. Fertility investigations may therefore include assessment of whether the tubes are open.

Endometriomas and ovarian reserve

An ovarian endometrioma is a cyst associated with endometriosis. Endometriomas and related inflammation may affect ovarian tissue and ovarian reserve. Surgery can also damage healthy tissue, particularly when it involves both ovaries or is repeated.

Ovarian reserve refers to the remaining supply of eggs. Anti-Müllerian hormone (AMH) and antral follicle count (AFC) can help clinicians assess reserve and anticipate the response to ovarian stimulation.

Egg quality, embryo development and implantation

Researchers have studied possible effects on egg quality, fertilisation, embryo development and the uterine environment. Some findings suggest effects in certain patients, but the evidence is not uniform.

It would be misleading to assume that every woman with endometriosis has poor-quality eggs or embryos. Age, ovarian reserve, disease location, sperm quality and other factors also matter.

There is no simple test that reliably explains every implantation problem. Repeated unsuccessful implantation should not automatically be attributed to endometriosis without considering other explanations.

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Can you get pregnant naturally with endometriosis?

Yes, natural conception is possible for many women with endometriosis. The likelihood depends on several factors:

• Your age and how long you have been trying.
• Whether your fallopian tubes are open and functioning.
• Whether ovulation occurs regularly.
• Your ovarian reserve.
• The location and extent of endometriosis.
• Your partner's sperm quality, where relevant.
• Any additional fertility conditions.

The stage of endometriosis alone cannot provide a complete prediction. Someone with apparently mild disease may experience difficulties, while someone with more extensive disease may conceive naturally.

An endometriosis diagnosis is not a prediction of your personal outcome.

Does endometriosis mean you will need IVF?

No. IVF is one possible treatment, not an inevitable outcome. Depending on your circumstances, a specialist may discuss trying naturally with monitoring, surgery, intrauterine insemination (IUI) or in vitro fertilisation (IVF).

IUI may be considered in selected cases when the tubes are open and other factors are favourable. IVF may be discussed when tubal function is compromised, other fertility factors are present, time is important in the overall assessment or other treatments have not succeeded.

The appropriate option depends on your history and test results. Treatment decisions should be individualised, rather than based on the diagnosis alone.

Can surgery improve fertility?

In selected cases, laparoscopic treatment may improve the chance of pregnancy. For some women with minimal or mild endometriosis, operative laparoscopy may improve ongoing pregnancy rates compared with diagnostic laparoscopy alone.

However, surgery is not automatically the best choice. Surgery for ovarian endometriomas can reduce ovarian reserve, particularly where reserve is already low, both ovaries are affected or previous ovarian surgery has taken place.

What about hormonal treatment?

Hormonal treatments are commonly used for endometriosis symptoms. However, hormonal suppression is not prescribed solely to improve spontaneous pregnancy rates in someone trying to conceive.

It may still be useful for pain management when pregnancy is not being attempted. Decisions should take account of symptoms, reproductive plans and medical history.

Do not stop or change prescribed medication without discussing it with your clinician.

Which fertility investigations might be discussed?

Your GP, gynaecologist or fertility specialist may consider:

• Pelvic ultrasound: to assess the ovaries and look for endometriomas or other abnormalities.
• Specialist ultrasound or MRI: where deep endometriosis is suspected or its extent needs assessment.
• AMH and AFC: to help assess ovarian reserve, particularly when planning treatment.
• Ovulation assessment: if your history suggests irregular ovulation.
• Fallopian tube assessment: where appropriate.
• Semen analysis: because fertility assessment should not overlook sperm-related factors.
• Other investigations: selected according to your history and results.

No single blood test establishes your complete fertility potential. Investigations should be chosen for your circumstances, rather than ordering every available test.

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Can diet or lifestyle reverse endometriosis?

Online claims about diets, supplements, detoxes or natural remedies can be tempting when you want answers. There is insufficient high-quality evidence to present a specific diet, supplement or complementary therapy as a proven way to increase pregnancy rates in women with endometriosis.

A balanced diet, movement, sleep and emotional support may help general wellbeing. They should not be presented as a cure or substitute for fertility care.

You do not have to blame yourself for your diagnosis or assume that lifestyle changes alone will solve fertility difficulties.

When should you seek fertility advice?

If you have diagnosed or suspected endometriosis and want to conceive, consider discussing your plans with your GP or fertility specialist early.

This is especially relevant if you are approaching your mid-thirties or older, have endometriomas, have had ovarian surgery, have been trying for some time or have other fertility concerns.

A specialist can help you understand suitable investigations and discuss whether trying naturally, surgery or treatment may be appropriate. In the UK, referral arrangements and NHS treatment eligibility depend on individual circumstances and local policies.

Your diagnosis does not tell the whole story

Living with endometriosis while trying for a baby can be physically and emotionally exhausting. Negative tests, appointments and unanswered questions may make the journey feel uncertain.

Some women conceive naturally. Some need medical support. Others need time to understand their options. There is no single journey everyone must follow.

You deserve a fertility plan based on your medical circumstances, not frightening assumptions or promises of a guaranteed result.

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This article is for educational purposes only and is not a substitute for personalised medical advice, diagnosis or treatment. Speak with a qualified healthcare professional about your symptoms and fertility options.

Sources and further reading

1. NICE: Fertility problems, assessment and treatment (NG257).
2. ESHRE guideline: Endometriosis (2022).
3. Becker and colleagues: ESHRE guideline, endometriosis. Human Reproduction Open (2022), hoac009.
4. NICE: Endometriosis, diagnosis and management (NG73), recommendations.

Evidence varies between treatments and proposed biological mechanisms. Research remains inconclusive in some areas; this article should not be interpreted as predicting an individual's chances of pregnancy.