Everything You Need to Know About Endometriosis & Fertility
Trying to conceive with endometriosis can bring up more questions than answers — about your body, your timeline, and your options. This guide breaks down what endometriosis means for fertility, so you can move forward with clarity and confidence.
Author
Tassia O’Callaghan
Reviewed by
Kayleigh Hartigan
14 min read
Condition spotlight:
- Endometriosis is a condition where tissue similar to the lining of the uterus grows elsewhere, such as on and around the pelvic and reproductive organs.
- Up to 10% of women at reproductive age have endometriosis, and it can affect women of all ages. [1]
- Endometriosis is a common condition, affecting around 1.5 million in the UK, and 17% of our founding community — those who have shared personal details, experiences and clinic reviews that are powering our new approach to fertility treatment. [2]
- Symptoms vary from person to person, most commonly it causes intense period pain.
- Research shows that there is now an average of 8 years and 10 months between someone first seeing a doctor about their symptoms and receiving a firm endometriosis diagnosis. [3]
- Fertility treatments recommended for those with endometriosis who are trying to conceive could include laparoscopic surgery (keyhole surgery), intrauterine insemination (IUI), in-vitro fertilisation (IVF), egg or embryo freezing.
What is endometriosis?
The lining of the uterus is called endometrium, it typically thickens throughout the menstrual cycle in readiness for an egg to implant, and sheds with every period. With endometriosis, similar tissue grows beyond the uterus, usually on or around the reproductive organs, including the fallopian tubes, ovaries and pelvic bowl. Unlike the endometrium within the uterus, this tissue doesn’t shed, it builds up, which can cause cysts and scarring, leading to symptoms that may impact fertility. [4]
There are also three types of endometriosis, which can determine your possible symptoms and the best course of treatment: [8]
- Peritoneal endometriosis (also called superficial endometriosis): The most common form, found on the surface of the pelvic cavity. Lesions can appear red, black, or white depending on how active they are. Red lesions tend to bleed during menstruation and are linked to inflammation and scar tissue. They may shrink with treatment but often return when periods resume.
- Ovarian endometriosis (endometriomas): These are fluid-filled cysts, often called “chocolate cysts,” that sit on the ovaries. They can cause pain and affect ovarian function. In rare cases, they can rupture and require emergency surgery.
- Deep infiltrating endometriosis (DIE): This type grows deep into the pelvic tissue and can affect structures like the bowel, bladder, and ligaments behind the uterus. It’s often associated with more severe symptoms and may need specialist surgical care.
Another condition sometimes confused with endometriosis is adenomyosis, which also involves tissue similar to the womb lining but develops within the muscle wall of the uterus.
What is silent endometriosis?
Silent endometriosis means having endometriosis with few or no obvious symptoms — no severe period pain, no bowel issues, no red flags. For some, the first sign is difficulty getting pregnant. [9]
It’s one of the reasons diagnosis can be delayed — or missed altogether. But just because it’s “silent” doesn’t mean it can’t affect fertility.
What causes endometriosis?
The cause of endometriosis is unknown, and it can affect women of any age — including up to 10% of women at reproductive age, around 190 million globally. There are several medically researched theories as to what causes endometriosis, including links to issues with the immune system. Genetics can also play a role, with links shown between first- and second-degree relatives (eg. your mother, and your grandmother or aunt) who have endometriosis; as well as endometriosis affecting certain ethnic groups more than others. [1,5,6]
Are you born with endometriosis or does it develop over time?
We don’t fully know. Some researchers believe endometriosis may begin before birth, while others suggest it develops during adolescence due to hormonal changes. Genetics likely play a role, too — having a first-degree relative with endometriosis increases your risk. [1]
Regardless of when it starts, symptoms often begin in the teenage years and worsen over time if left untreated.
What are the symptoms of endometriosis?
The symptoms of endometriosis vary from person to person. Some might not have any noticeable symptoms, while others might be extremely affected. The most common symptoms include: [4]
- Painful and/or heavy periods
- Pain during or after sex
- Painful bowel movements
- Pain when urinating
- Chronic pelvic pain
- Fertility issues
How does endometriosis affect fertility?
Up to 50% of women with endometriosis will see the condition impact their fertility. This could be influenced by the following factors: [7,10]
- Pelvic adhesions and scarring: The growth of endometrial tissue can cause adhesions around and distortion of the reproductive organs including the uterus and fallopian tubes. The risk of blocked fallopian tubes increases with the severity of endometriosis. These factors reduce the ease of the egg reaching the uterus to be fertilised.
- Cysts on the ovaries: Endometriosis can lead to cysts on the ovaries, endometriomas, which can damage the ovarian tissues and follicles that hold eggs before they are released; therefore impacting egg quality and quantity.
- Immune system response: In some cases, it is thought that the endometrial tissue might trigger a heightened response from the body’s immune system, causing inflammation which could impact the reproductive system.
- Inflammation in the pelvic area: This can affect egg quality, embryo implantation, and sperm function.
At what stage does endometriosis cause infertility?
The stage of endometriosis doesn’t always predict your fertility outlook — someone with mild disease may struggle to conceive, while another with severe endometriosis may not. But broadly speaking, the more extensive the endometrial tissue and scarring, the greater the chance it may affect fertility. [11,12]
Endometriosis is found in around 1 in 4 people undergoing fertility investigations, but most people with the condition will still conceive naturally — sometimes with time, sometimes with treatment. It’s less about the “stage” and more about your individual symptoms, goals, and fertility profile. That’s why tailored care is essential. [11]
How to Choose the Best Fertility Clinic
How is endometriosis diagnosed?
In the UK, getting an endometriosis diagnosis can be a lengthy and frustrating process – research shows that there is now an average of 8 years and 10 months between someone first seeing a doctor about their symptoms and receiving a firm endometriosis diagnosis. [3]
The path usually starts with a trip to the GP, who will ask about symptoms (it might help to keep a diary) and may do a pelvic examination — GPs are not usually experts in endometriosis, therefore may not be best placed to test or help. This will be followed by a referral to a gynaecologist for further tests, which can include an ultrasound (abdominal or transvaginal), an MRI and/or laparoscopy (keyhole surgery) to assess and in some cases operate on the endometriosis tissue.
“My advice to anyone that suspects they have endometriosis or other potential fertility issues would be to push your GP to refer you to a gynaecologist. Bleeding so heavily you daren’t leave the house and pain that stops you from functioning are definitely not normal. GPs can be great, but they aren’t specialists, and an earlier diagnosis can help to give you more control and choice in when/if you decide to try to conceive.”
How is endometriosis managed?
There’s no cure for endometriosis — but there are ways to manage it. Because it’s a chronic condition, treatment is often long-term, layered, and deeply personal. The goal is to reduce pain, improve daily function, and support your wellbeing over time, not just in the short term.
Treatment plans are usually based on a combination of factors: your symptoms, age, whether or not you’re trying to conceive, and how the condition is affecting your life. For many people, the most effective approach involves a mix of medical and lifestyle support — sometimes alongside surgery if symptoms are severe or complex.
Medical management
Medical treatment is usually the first step — they won’t remove existing endometriosis tissue, but they can stop it from growing or spreading further. Medical treatments for endometriosis can include: [14,10]
- Hormonal therapy: Such as the combined pill, progestin-only pill, hormonal IUDs, or injections — to reduce or stop periods and limit the growth of endometriosis tissue. Many people find this helps reduce pain and inflammation.
- GnRH analogues and antagonists: These work by temporarily putting the body into a low-oestrogen state. While often effective for pain, they can cause menopause-like side effects, so are typically used short-term and sometimes combined with hormone add-back therapy.
- Dienogest: A newer treatment specifically licensed for endometriosis, which can reduce pain and slow the growth of tissue, with fewer side effects for many.
- NSAIDs: Like ibuprofen, which help manage pain, especially during periods.
Surgical management
If other treatments aren’t helping — or if endometriosis is widespread — surgery may be offered as a next step. It’s also an option if the condition is affecting your fertility or organs like the bladder or bowel. [4]
Surgical procedures for endometriosis can include:
- Removing endometriosis tissue or ovarian cysts (endometriomas) to relieve pain and restore function.
- Hysterectomy (removal of the womb) or oophorectomy (removal of the ovaries), typically for those who’ve completed their families or when other options haven’t worked.
- Removing part of the bladder or bowel, in cases where endometriosis has grown into these areas and is causing symptoms or complications.
Surgery is usually done via laparoscopy (keyhole surgery), and in many cases, the aim is to ease symptoms, improve quality of life, and reduce the need for repeated interventions. If you’re considering surgery, your care team should walk you through the risks, benefits, and whether it aligns with your goals — now and in the future.
Lifestyle and complementary approaches
Medical and surgical treatments aren’t the only tools available. Many people with endometriosis find that combining conventional treatment with supportive therapies makes a difference to daily quality of life. [13,14,15]
Options that may help include:
- Heat therapy: A hot water bottle, heat pad, or warm bath can help soothe pelvic pain. Some people find heated wheat bags particularly effective.
- TENS machines: These small devices send gentle electrical pulses through the skin, helping to block pain signals and encourage endorphin release. Check with your GP before use, especially if you’re pregnant or have a heart condition.
- Pain clinics: If your pain feels hard to manage, ask your GP about a referral to a specialist pain service for more personalised support.
- Physiotherapy: A pelvic health physio can support you with gentle, targeted exercises to reduce pain, improve muscle function, and support recovery after surgery.
- Exercise: Regular movement can reduce inflammation, balance hormones, and ease stress. That might mean walking, swimming, yoga, or simply dancing around the kitchen — whatever feels good for your body.
- Pelvic floor exercises: Strengthening these muscles can help with pain, bladder symptoms, and posture.
- Prioritise sleep: Poor sleep can increase inflammation and worsen symptoms. Build a calming bedtime routine, and listen to your body when it needs rest.
- Manage stress: Stress affects both your body and hormones. Meditation, breathwork, journaling, or connecting with a support group can all help. Talking openly about how you feel — with someone you trust or in a safe community — can make a big difference.
How does endometriosis affect fertility treatment?
For those who are trying to conceive, treatment could include:
- Laparoscopic surgery (keyhole surgery) to remove any adhesions and tissue build up, aiming to improve structural issues or blockages in and around the pelvic organs and reduce inflammation; or to remove cysts on the ovaries caused by endometriosis.
- Intrauterine insemination (IUI), which is usually offered to those with more mild endometriosis, due to the potential effect on the fallopian tubes.
- In-vitro fertilisation (IVF), which is usually offered to those with more severe endometriosis.
- Egg or embryo freezing could also be a recommended option for those with endometriosis, ahead of any planned surgery to treat the condition.
Can you get IVF with endometriosis?
Yes — many people with endometriosis do IVF. In fact, it’s a common treatment recommendation when endometriosis is affecting fertility, particularly if there’s damage to the fallopian tubes, ovarian function is reduced, or previous treatments haven’t led to pregnancy. IVF can bypass some of the barriers endometriosis creates, offering another pathway to parenthood.
Is IVF less effective if you have endometriosis?
Endometriosis can affect IVF outcomes — but how much depends on the stage and severity. Research suggests that people with Stage III or IV endometriosis may have slightly lower success rates, particularly if ovarian function is reduced or there’s significant pelvic inflammation. That said, many people with endometriosis do conceive through IVF, and for some, it’s their most effective option. Your fertility team can help assess your personal chances and tailor treatment to improve them. [16]
Find the right clinic for you
Choosing a clinic is one of the biggest decisions you’ll make. We’ll find the best options for you and arrange your pre-treatment tests, empowering you from this point onwards.
Where can I find more support on endometriosis?
According to the charity Endometriosis UK, 1.5 million women and those assigned female at birth are currently living with the condition. This includes 17% of our founding community — those who have shared personal details, experiences and clinic reviews that are powering our new approach to fertility treatment. You can find the reviews of those with endometriosis by searching the tag ‘Endo’. [2]
Community is at the heart of everything we do, shaping our work and the experiences of others on their fertility path.
Connecting with each other, whether in person at local groups or online, can be a great way to offer or find support, share experiences and learn more from people who are in a similar position. Find the groups that are right for you on our Communities page.
A final note on endometriosis
Endometriosis is a condition that affects everyone differently and can impact all areas of life, physically, mentally and emotionally. If you have endometriosis and are thinking about fertility treatment, we can help to match you with a clinic that is highly rated and experienced when it comes to treating others with the same condition.
Endometriosis and fertility FAQs
Can you get pregnant if you have endometriosis?
Yes — many people with endometriosis do conceive naturally. But for others, it can take longer or require fertility treatment.
Can you have endometriosis and be very fertile?
It’s possible. Endometriosis affects everyone differently. Some people with mild or even severe endometriosis have no trouble conceiving. Others may struggle, even with minimal symptoms. That’s why personalised support is key.
What age is best to get pregnant with endometriosis?
There’s no one-size-fits-all age — but age does matter. Egg quality declines with time, and endometriosis can progress or reoccur. So, if pregnancy is a goal, speaking to a specialist sooner rather than later can give you more options.
That doesn’t mean rushing. It means being informed, supported, and proactive — with a plan that works for your body and life.
Does endometriosis affect egg quality?
Not necessarily — but it can reduce egg quality or quantity, especially if:
- You have endometriomas (ovarian cysts)
- There’s inflammation in or around the ovaries
- You’ve had surgery that affected ovarian tissue
That said, many people with endometriosis still have healthy eggs and go on to conceive. If you’re concerned about your ovarian reserve, tests like AMH and AFC (antral follicle count) can help give a clearer picture.
Is endometriosis a form of infertility?
Not exactly. Endometriosis is a condition that can make conception harder for some, but it doesn’t mean you’ll definitely be infertile.
Can pregnancy cure endometriosis?
Pregnancy can temporarily suppress symptoms due to hormonal shifts, but it’s not a cure. Symptoms often return after birth or weaning.
Sources
1. https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics
2. https://www.endometriosis-uk.org/what-endometriosis
3. https://www.endometriosis-uk.org/diagnosis-report
4. https://www.nhs.uk/conditions/endometriosis/
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911462/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066945/
7. https://www.fertstert.org/article/S0015-0282(08)00975-8/fulltext
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC3096669/
9. https://uijir.com/wp-content/uploads/2024/01/8.8.-ENDOMETRIOSIS.pdf
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC2941592/
11. https://flipbooks.leedsth.nhs.uk/LN005669.pdf
12. https://www.leedsth.nhs.uk/patients/resources/deep-infiltrating-endometriosis/
13. https://www.endometriosis-uk.org/pain-relief-endometriosis
14. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/endometriosis/
15. https://www.theendometriosisfoundation.org/diet-and-lifestyle
16. https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01157-8