Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause pelvic pain, painful periods, pain during intercourse and other symptoms. For some women, endometriosis may also affect fertility.
If you have been diagnosed with endometriosis and are trying to conceive, it is natural to ask: Can I get pregnant with endometriosis?
The answer is yes. Many women with endometriosis become pregnant naturally or with fertility treatment. However, the condition can sometimes make conception more difficult, particularly when it causes inflammation, adhesions, ovarian endometriomas or changes to the pelvic anatomy.
Understanding how endometriosis may affect fertility can help you decide when evaluation or treatment may be appropriate.
What Is Endometriosis?
Endometriosis occurs when tissue similar to the endometrium grows outside the uterus. These areas may develop around the:
- Ovaries
- Fallopian tubes
- Pelvic lining
- Uterus
- Bladder or bowel
- Other pelvic structures
The condition may cause inflammation and scar tissue, sometimes leading to adhesions between pelvic organs.
Common symptoms include:
- Painful periods
- Chronic pelvic pain
- Pain during sex
- Pain during bowel movements
- Pain while urinating, particularly around menstruation
- Heavy or irregular bleeding
- Difficulty becoming pregnant
If painful periods are affecting your daily life, read our detailed guide on Endometriosis Pain: Causes, Symptoms & Ways to Manage It to understand common causes and treatment approaches.
Can Endometriosis Cause Infertility?
Endometriosis is associated with reduced fertility in some women, although the relationship is complex.
The American Society for Reproductive Medicine (ASRM) explains that endometriosis can be associated with infertility, but the exact relationship between the severity of disease and fertility is not always straightforward.
Endometriosis may affect fertility through several possible mechanisms.
1. Pelvic adhesions
Inflammation caused by endometriosis can lead to scar tissue and adhesions.
Severe adhesions may alter the normal relationship between the ovaries and fallopian tubes, potentially interfering with the release or transport of the egg.
2. Endometriomas
An ovarian endometrioma, sometimes called a “chocolate cyst,” develops when endometriosis affects an ovary.
Endometriomas may affect ovarian function, and treatment decisions need to consider both the endometriosis and the woman’s fertility goals.
3. Inflammation
Endometriosis is associated with inflammatory changes within the pelvis. These changes may potentially influence sperm, eggs, embryos or the reproductive environment.
4. Changes in pelvic anatomy
Advanced endometriosis can cause significant scarring and distortion of pelvic structures.
This may interfere with the normal interaction between the egg, fallopian tube and sperm.
5. Possible effects on implantation and ovarian function
Researchers have proposed several mechanisms involving ovarian function, embryo development and endometrial receptivity. However, not all proposed mechanisms have been conclusively established.
Can You Get Pregnant Naturally With Endometriosis?
Yes, pregnancy is possible with endometriosis.
Having endometriosis does not automatically mean that you will be infertile.
Some women with mild disease conceive naturally without fertility treatment, while others may require assistance depending on factors such as:
- Age
- Duration of trying to conceive
- Severity and location of endometriosis
- Ovarian reserve
- Fallopian tube function
- Previous pelvic surgery
- Presence of endometriomas
- Male partner’s fertility
If you are trying to conceive, understanding your fertile window can be useful. Our guide to Signs of Ovulation: How to Know When You Are Most Fertile explains cervical mucus changes, ovulation symptoms and ways to track fertility.
Treatment for endometriosis depends on your symptoms, disease severity and pregnancy plans. If you are not currently trying to conceive, non-surgical endometriosis treatment may include medicines, hormonal therapy and approaches aimed at controlling pain and symptoms.
Because treatment choices can be different for women trying to conceive, it is important to discuss your fertility plans before starting hormonal therapy. Learn more about endometriosis medicines and hormone treatment and how treatment choices are individualized
For some women with endometriosis-related infertility, surgical treatment may be considered depending on the location and severity of the disease. Learn about laparoscopy for endometriosis and how surgery may affect fertility and future pregnancy planning.
Does Endometriosis Affect Ovulation?
Endometriosis does not necessarily stop ovulation.
Many women with endometriosis continue to ovulate normally. However, pelvic inflammation, ovarian endometriomas, ovarian surgery and other associated reproductive factors can affect fertility.
This is different from conditions in which irregular or absent ovulation is the main cause of infertility.
For example, PCOS can interfere with ovulation and conception. If you are unsure whether your difficulty conceiving is related to endometriosis, PCOS or another condition, our PCOS Symptoms and Management Guide explains how hormonal disorders can affect reproductive health.
How Does Endometriosis Affect Pregnancy?
For many women, pregnancy progresses normally despite a history of endometriosis.
However, some studies have found associations between endometriosis and certain pregnancy complications. ASRM’s review reported higher rates of conditions including preterm birth, pre-eclampsia, antepartum bleeding/placental complications and caesarean delivery among women with endometriosis, although the reasons for these associations are not always clear.
This does not mean that every woman with endometriosis will experience pregnancy complications.
Once pregnancy occurs, your obstetrician can assess your individual medical history and determine whether additional monitoring is appropriate.
For women who are already pregnant or planning pregnancy, our Early Pregnancy Symptoms Week-by-Week Guide explains common early pregnancy changes and warning signs.
Does Endometriosis Increase Miscarriage Risk?
Research regarding miscarriage and endometriosis is complex.
A diagnosis of endometriosis does not mean that miscarriage will occur. Your overall risk depends on multiple factors, including age, reproductive history and other medical conditions.
If you have experienced repeated pregnancy losses, a separate evaluation may be necessary rather than assuming that endometriosis is the only cause.
Endometriosis and Fertility: When Should You Seek Help?
If you have endometriosis and are trying to conceive, it is reasonable to discuss fertility planning with a gynecologist earlier rather than waiting indefinitely.
Consider seeking medical advice if you:
- Have known moderate or severe endometriosis
- Have an ovarian endometrioma
- Have undergone previous pelvic surgery
- Have severe pelvic pain
- Have known fallopian tube problems
- Are concerned about declining ovarian reserve
- Have been trying to conceive without success
ASRM recommends considering factors such as age, duration of infertility, pelvic pain and stage of endometriosis when developing a fertility treatment plan.
If you are having difficulty conceiving, our Female Infertility: Causes and Treatment Guide can help you understand the broader range of fertility factors that may need evaluation.
How Is Endometriosis-Related Infertility Diagnosed?
Fertility evaluation may include:
Medical history
Your doctor may ask about:
- Period pain
- Pelvic pain
- Previous pregnancies
- Previous surgery
- Duration of trying to conceive
- Menstrual cycle pattern
- Previous endometriosis diagnosis
Ultrasound
Transvaginal ultrasound can help identify ovarian endometriomas and other pelvic abnormalities.
Ovarian reserve assessment
Depending on your age and history, your doctor may consider tests that assess ovarian reserve.
Fallopian tube evaluation
Tests such as hysterosalpingography may be considered when appropriate to determine whether the fallopian tubes are open.
Semen analysis
Infertility evaluation should not focus only on the woman. Male fertility factors can also contribute to difficulty conceiving.
A fertility evaluation may therefore need to assess both partners.
Can Endometriosis Be Treated to Improve Fertility?
Treatment depends on the woman’s symptoms, age, disease severity and pregnancy plans.
There is no single treatment that is appropriate for every woman with endometriosis and infertility.
Treatment may include:
- Expectant management
- Pain management
- Laparoscopic surgery in selected cases
- Ovulation-related fertility treatment when appropriate
- Intrauterine insemination (IUI)
- In-vitro fertilization (IVF)
Importantly, hormonal treatments used to suppress endometriosis are generally intended for symptom control rather than to improve fertility while actively trying to conceive. ASRM notes that medical suppression of endometriosis has not been shown to improve fertility.
Is Surgery Recommended for Endometriosis and Infertility?
Not every woman with endometriosis needs surgery.
For some women, laparoscopic treatment may be considered based on the extent of disease, pain, ovarian endometriomas, pelvic adhesions and fertility plans.
However, surgery must be carefully individualized because ovarian surgery can potentially affect ovarian reserve.
ASRM notes that the benefit of laparoscopic treatment for minimal or mild endometriosis solely to increase the chance of pregnancy is limited, while surgery may have a role in selected women with more advanced disease.
If you are interested in minimally invasive gynecological procedures, you can also learn about Laparoscopic Hysterectomy: Procedure, Benefits & Recovery. Note that hysterectomy itself is not a fertility-preserving treatment and is not an option for women who wish to become pregnant.
Endometriosis and IVF
IVF may be considered when endometriosis is associated with infertility, particularly when:
- Other fertility treatments have not worked
- Fallopian tubes are damaged or blocked
- Endometriosis is moderate or severe
- There are additional infertility factors
- Age or ovarian reserve makes delaying treatment less desirable
ASRM notes that IVF can be an effective fertility option for women with more advanced endometriosis who have not conceived after appropriate treatment.
The decision to proceed with IVF should be individualized rather than based solely on the presence of endometriosis.
If you are planning pregnancy, understanding the fertile period can also be helpful. Our guide to Understanding Your Menstrual Cycle explains how menstruation, ovulation and the luteal phase fit together.
Does Endometriosis Treatment Guarantee Pregnancy?
No.
Treatment can address pain, endometriosis lesions or fertility barriers, but no treatment can guarantee pregnancy.
Fertility depends on multiple factors, including:
- Age
- Ovarian reserve
- Egg quality
- Sperm quality
- Fallopian tube function
- Severity of endometriosis
- Previous surgery
- Overall reproductive health
This is why fertility treatment should be personalized.
What Can You Do If You Have Endometriosis and Want to Get Pregnant?
If you are planning pregnancy:
1. Discuss your fertility plans early
Tell your gynecologist that you want to conceive. Treatment decisions can be different when fertility is an immediate goal.
2. Track ovulation
Understanding your fertile window may help with timing intercourse.
3. Don’t ignore severe pelvic pain
Severe or progressively worsening period pain deserves evaluation.
4. Consider fertility assessment when appropriate
Do not assume that endometriosis is the only reason for difficulty conceiving.
5. Consider your age
Age is an important factor in fertility planning. If you are older than 35 and have known endometriosis, discussing fertility sooner may be particularly important.
6. Maintain healthy lifestyle habits
A balanced diet, regular physical activity, adequate sleep and avoiding smoking are important for overall reproductive health.
If you are preparing for pregnancy, our Preconception Counseling Guide can help you understand health checks, nutrition and preparation before conception.
Endometriosis and Pregnancy: Important Takeaway
Endometriosis can affect fertility, but it does not mean that pregnancy is impossible.
Many women with endometriosis conceive naturally, while others may need fertility treatment. The impact on fertility depends on factors such as the extent of disease, ovarian involvement, pelvic adhesions, fallopian tube function, age and other fertility factors.
The most important step is not to assume that endometriosis automatically means infertility. Instead, discuss your symptoms and pregnancy plans with a gynecologist so that the most appropriate approach can be chosen.
When to See a Gynecologist or Fertility Specialist
Consider an evaluation if you have:
- Known endometriosis and want to become pregnant
- Severe or worsening period pain
- Chronic pelvic pain
- Pain during intercourse
- An ovarian endometrioma
- Previous endometriosis surgery
- Difficulty conceiving
- Previous fertility treatment without success
Early evaluation can help identify potentially treatable factors and avoid unnecessary delays.
Frequently Asked Questions
1. Can endometriosis cause infertility?
Endometriosis is associated with infertility in some women. Pelvic adhesions, ovarian endometriomas, inflammation and changes in pelvic anatomy may contribute to reduced fertility. However, many women with endometriosis become pregnant.
2. Can you get pregnant naturally with endometriosis?
Yes. Many women with endometriosis conceive naturally. The likelihood depends on factors such as age, disease severity, ovarian function, fallopian tube health and sperm factors.
3. Does endometriosis stop ovulation?
Not necessarily. Many women with endometriosis continue to ovulate normally. Fertility problems may occur through other mechanisms, including pelvic adhesions or ovarian involvement.
4. Does endometriosis affect pregnancy?
Endometriosis may be associated with an increased risk of some pregnancy complications, but many women with endometriosis have healthy pregnancies. Individual risk should be assessed by the treating obstetrician.
5. Is IVF successful with endometriosis?
IVF can be an effective treatment option for some women with endometriosis-associated infertility. Success depends on age, ovarian reserve, disease severity and other fertility factors.
6. Does surgery for endometriosis improve fertility?
Surgery may improve fertility in selected women, particularly when significant disease or pelvic adhesions are present. However, surgery is not automatically recommended for every woman with endometriosis who wants to conceive.
7. Should endometriosis be treated before trying to get pregnant?
Not always. Treatment depends on symptoms, age, ovarian reserve, disease severity and fertility goals. Some women may be advised to try naturally, while others may benefit from fertility treatment or surgery.
8. Can endometriosis cause miscarriage?
Research on the relationship between endometriosis and miscarriage is complex. Having endometriosis does not mean that miscarriage will occur. Other individual risk factors should also be considered.
9. When should I see a fertility specialist with endometriosis?
Consider earlier fertility evaluation if you have moderate or severe endometriosis, an endometrioma, previous pelvic surgery, tubal problems, reduced ovarian reserve or difficulty conceiving.
10. Does endometriosis always mean IVF is needed?
No. IVF is only one possible fertility treatment. Some women conceive naturally, while others may benefit from timed intercourse, IUI, surgery or IVF depending on their circumstances.
Authoritative Medical References
For patients who want to read the evidence behind the relationship between endometriosis and fertility, the American Society for Reproductive Medicine (ASRM) guidance on endometriosis and infertility provides a detailed review of fertility, surgery, medical treatment and IVF.
The ASRM fertility evaluation guidance also explains why endometriosis and pelvic adhesions may be considered during infertility assessment and when further evaluation may be appropriate.
You can also review the World Health Organization’s information on endometriosis for an overview of the condition, symptoms and its impact on women’s health.
Conclusion
Endometriosis and infertility can be closely connected, but having endometriosis does not mean you cannot become pregnant. Many women with endometriosis conceive naturally, while others may need fertility evaluation or treatment. The effect on fertility depends on factors such as the extent of endometriosis, ovarian involvement, fallopian tube function, age, ovarian reserve and other fertility factors.
If you have endometriosis and are planning a pregnancy, discussing your fertility goals with a gynecologist or fertility specialist can help you choose the right approach. Early evaluation can be particularly helpful when there is severe endometriosis, an endometrioma, previous pelvic surgery, tubal problems or difficulty conceiving.
With appropriate assessment and individualized care, many women with endometriosis can successfully achieve pregnancy.
Medical Disclaimer
Disclaimer: This article is intended for general educational and informational purposes only. It does not replace professional medical advice, diagnosis or treatment from a qualified gynecologist, fertility specialist or other healthcare professional. Endometriosis and its effects on fertility and pregnancy can vary from woman to woman. Treatment and fertility decisions should be based on your individual medical history, examination and investigations. If you have severe pelvic pain, difficulty conceiving, abnormal bleeding or concerns during pregnancy, consult a qualified healthcare professional for personalized advice.
