If you're living with endometriosis, you already know how much it can affect your daily life, and if you're also hoping to start or grow your family, the worry can feel overwhelming. Endometriosis is a chronic condition in which tissue similar to the uterine lining grows outside the uterus, forming lesions called endometrial implants1. Over time, these implants can trigger inflammation, adhesions, and scar tissue around nearby organs. These implants can show up in different reproductive organs, such as the ovaries, fallopian tubes, and the outer surface of the uterus. Endometriosis affects about 10% of women2 of reproductive age (15-49) globally, although it’s more common in women in their 30s and 40s.
What makes endometriosis particularly frustrating for you is that this displaced tissue behaves like the normal uterine lining, thickening and breaking down with each menstrual cycle. But unlike healthy uterine lining, it has no exit route, so it triggers inflammation, pain, and adhesions. Researchers still don’t know what causes endometriosis, and there’s no known way to prevent it, which we know can feel disheartening when you’re looking for answers.
There are four main manifestations of endometriosis:
- Superficial peritoneal endometriosis. In this type of endometriosis, the endometrial tissue attaches to the peritoneum, a thin membrane that lines the abdomen and pelvis.
- Endometriomas. These are dark, fluid-filled cysts, also called ovarian endometriomas or “chocolate cysts.” They show up in different sizes and can appear in different parts of the pelvis or abdomen, but they’re most common in the ovaries.
- Deeply infiltrating endometriosis (DIE). In DIE endometriosis, the endometrial tissue has invaded the organs either within or outside the pelvic cavity, which can include the ovaries, rectum, bladder, and bowels. In rare cases, the scar tissue can bond organs, making them become stuck in place.
- Abdominal wall endometriosis. Endometrial tissue can sometimes grow on the abdominal wall. The cells may attach to a surgical incision, like one from a C-section.
We know this is a lot to take in, so let’s talk about what it means for your fertility. One study shows that the endometriosis infertility rate ranges between 30% to 50%3, though researchers are still studying this. So how does endometriosis cause infertility? It may distort pelvic anatomy, scar your fallopian tubes, create adhesions, inflame the reproductive organs, alter hormonal and immune function, reduce egg quality, and impair implantation.
But here's what we really want you to hear: an endometriosis diagnosis doesn’t mean you cannot get pregnant. In fact, it’s estimated that 60-70%4 of women with endometriosis can conceive without medical intervention.
Key Takeaways
- Endometriosis affects an estimated 30-50% of women with the condition in terms of fertility difficulties3, but many women with endometriosis do conceive naturally.
- The condition can impair fertility through inflammation, scarring, fallopian tube distortion, reduced egg quality, and a less hospitable implantation environment.
- Surgical treatment can improve natural conception rates in some cases, particularly where tubes or ovaries are affected.
- Fertility treatment options, natural conception with monitoring, IUI, and IVF, depend on the stage and location of the condition.
- Anti-inflammatory nutrition and antioxidant supplementation may support reproductive health alongside medical treatment.
How is Endometriosis Diagnosed?
If you suspect you might have endometriosis, getting a clear diagnosis is an important first step, and you have every right to advocate for yourself in that process. Doctors usually diagnose endometriosis through a combination of medical history, clinical examinations, and imaging studies. Only a surgical procedure called laparoscopy can definitively confirm it, but your doctor might suspect endometriosis based on your symptoms. To reach a diagnosis, your doctor may perform several tests, including:
- Medical history and symptom assessment. If your doctor suspects endometriosis, they’ll usually start with a thorough interview about your symptoms and reproductive history. Talking in detail about the nature, intensity, and duration of what you’re feeling helps them establish a baseline for further evaluation. Your doctor may also ask about your family history. This matters because some studies show that when there’s a generational link, endometriosis can worsen from one generation to the next5.
- Physical examination. Your doctor may also perform a pelvic exam to check for any abnormalities, such as the presence of tender nodules or masses.
- Imaging studies. In some cases, imaging studies (such as ultrasound, CT scan, or MRI), may be used to visualise potential lesions.
- Diagnostic laparoscopy. This is the standard for confirming endometriosis. A laparoscopy is a minimally invasive procedure that involves inserting a thin, lighted tube through small incisions in the abdomen to visualise and take small samples of any suspicious lesions. Laparoscopy allows for both diagnosis and, in some cases, simultaneous treatment by removing endometriotic tissue.
- Biopsy. In a biopsy, the tissue samples obtained during laparoscopy are sent to a laboratory for further examination. This analysis can confirm the presence of endometrial-like tissue outside the uterus and helps distinguish endometriosis from other conditions.
What Are the Symptoms of Endometriosis?
One of the most challenging things about endometriosis is that it looks and feels different for everyone. Some women don’t notice any symptoms at all, while others deal with symptoms that can really disrupt daily life. Here are some of the most common signs for you to be aware of:
Pelvic Pain
Pelvic pain is one of the most common symptoms of endometriosis, and for many women, it goes far beyond “normal” period discomfort. The pain can range from mild to severe and debilitating, and it often doesn’t respond to over-the-counter (OTC) medications. You may feel it before, during, or after your period, and often deep within the pelvis. Intensity and location vary widely from person to person, which is part of what makes endometriosis so hard to pin down.
Menstrual Irregularities
While an irregular period certainly isn’t always a sign of endometriosis (most women will experience irregular periods at some point), it can be a symptom worth paying attention to. You may notice that your period is shorter or longer than usual, or that you experience heavy menstrual flow, or spotting between periods. While it’s rare, some people with endometriosis may also have no periods at all. These period irregularities are often caused by the presence of endometrial-like scar tissue outside the uterus.
Pain During Intercourse
Many women find this difficult to talk about, but it’s more common than you might think. Dyspareunia, or painful sex, is a symptom of endometriosis that can cause deep pelvic pain. Inflammation and deep endometriosis nodules in the area between the vagina and rectum (the rectovaginal septum) often drive this pain, because that’s where pressure during sex concentrates. How intense the pain feels depends on where the endometriosis sits and how extensive it is, and some positions may hurt more than others for the same reason.
Pain with Bowel Movements or Urination
If you have endometriosis, you may feel pain or discomfort in the pelvic region during bowel movements or urination. This happens when endometrial tissues affect adjacent pelvic organs like the bladder or intestines. The pain tends to be more severe during menstruation, though every person’s experience is different.
Infertility
If you’re living with endometriosis, your fertility can sometimes be affected, and we understand how worrying that feels. Endometrial tissue growing outside the uterus can cause scarring, adhesions, and structural changes in your reproductive organs. That can interfere with how your ovaries, fallopian tubes, and uterus work, making it harder to conceive and maintain a pregnancy. Learn more about the common causes of infertility in women.
Fatigue, Diarrhoea, Constipation, Bloating or Nausea
Endometriosis doesn’t just stay in the pelvic region. It can affect your whole body in ways that might surprise you. Alongside pelvic pain and discomfort, you may also experience fatigue and gastrointestinal issues such as bloating, constipation, and diarrhoea. Some people with endometriosis also have related conditions like irritable bowel syndrome (IBS), autoimmune diseases, and asthma. Researchers think the inflammatory response triggered by endometrial-like tissue outside the uterus drives these symptoms.
Chronic Lower Back Pain
Chronic lower back pain is also a common symptom of endometriosis. This pain may radiate from your pelvic region to your lower back, leading to overall discomfort and making everyday activities harder than they should be.
Painful Menstrual Cramps
Although over 80% of women experience painful periods6 at some point, if you have endometriosis you’ll often experience more intense and prolonged cramping during menstruation. If you’ve felt like your period pain is on another level compared to what others describe, you’re not imagining it. These cramps can be severe, and OTC medications often don’t touch them.
Why Does Endometriosis Cause Infertility?
Understanding why endometriosis can affect your fertility is a natural part of coming to terms with a diagnosis, and the more you know, the more empowered you’ll feel to explore your options. Endometriosis is a complex condition that can impact fertility through various mechanisms7. It doesn’t necessarily cause infertility, but evidence suggests it can make conceiving harder. For example, if endometrial tissue implants around your ovaries and fallopian tubes, the resulting inflammation and scarring can block the fallopian tubes8 and make it harder for the egg to travel to the uterus and fertilize.
A separate but related condition called adenomyosis9, in which endometrial-like tissue grows into the muscular wall of the uterus, sometimes occurs alongside endometriosis. This condition can result in an enlarged uterus, severe menstrual cramps, and heavy bleeding during periods, which can further complicate your reproductive landscape and potentially impact fertility outcomes. Adenomyosis is most common in women in their 40s and 50s10, though approximately 20% of adenomyosis cases occur in women under the age of 40, though more recent imaging-based studies suggest adenomyosis may be more common in younger women than previously recognised. For those who previously conceived without difficulty, adenomyosis may be related to secondary infertility.
The inflammation associated with endometriosis11 can also create an environment that makes conception tougher for you. It can adversely affect your egg quality, sperm function and motility, and hinder how a fertilized egg implants in your uterus.
It’s also worth keeping in mind that age is the single most important factor12 affecting your fertility and ability to have a healthy baby. You were born with a limited lifetime supply of eggs that undergo maturation each month once you reach puberty. Unfortunately, your body isn’t capable of making new eggs, and fertility declines more rapidly from the mid-30s onwards due to a decline in both the number and the quality of remaining eggs, with egg quality (specifically, the proportion of chromosomally normal eggs) becoming the dominant factor in the late 30s and early 40s. This means that while endometriosis may increase your risk for infertility, it’s just one piece of a much bigger fertility picture.
| Stage | Description | Impact on Fertility | Main Treatment Options |
|---|---|---|---|
| Stage I, Minimal | Small isolated lesions; no scar tissue | Mild reduction; many conceive naturally | Monitoring (expectant management); IUI |
| Stage II, Mild | More lesions present; shallow implants | Moderate reduction in natural fertility | IUI; IVF (hormonal therapy may be used between conception attempts but suppresses ovulation) |
| Stage III, Moderate | Deep implants; some adhesions forming | Significant reduction; tubes may be affected | Surgical removal; IVF |
| Stage IV, Severe | Extensive implants; major adhesions; possible ovarian endometrioma | Severe impact on ovaries and tubes | Surgery + IVF; donor eggs in some cases |
Can You Still Get Pregnant with Endometriosis?
This is probably the question weighing on you most, and we want to be straightforward with you: yes, many women with endometriosis conceive naturally and have successful pregnancies and healthy babies. If you’ve been diagnosed and are trying to conceive, it’s completely normal to feel anxious and concerned. Those feelings are valid.
Even if it may take longer or the journey is a little more difficult than what you might have expected, please don't give up on your dream of becoming a mother. Here’s why there's real reason for hope:
It Doesn’t Mean You’re Infertile
Can endometriosis affect fertility? Yes, but that doesn’t automatically mean you won’t have children. With advances in reproductive medicine and a healthy approach to preconception, many people with endometriosis go on to achieve their dream of motherhood. Fertility is a complex interplay of hundreds of factors, and many women with endometriosis have successfully conceived and given birth to healthy babies.
There are Many Treatment Options
If you’ve been diagnosed with endometriosis and are trying to conceive, it helps to know that there are many treatment options available13, including:
- Medical management to improve hormonal balance and induce ovulation
- Surgical interventions to remove endometrial implants and adhesions
- Assisted reproductive technology (ART) procedures, such as in vitro fertilisation (IVF) and intrauterine insemination (IUI)
You Don’t Have to Stop Trying
Endometriosis may introduce some obstacles, but it absolutely doesn’t mean you need to give up on your dreams of starting a family. Many women with endometriosis conceive naturally, and others get there with the help of medical interventions. Every fertility journey is unique, and some may require extra time and patience. Seeking guidance from reproductive specialists, taking care of your physical and mental health through supportive exercise and nutrition, and exploring your fertility options can empower you to keep moving forward toward parenthood.
About FertilitySmart
Supporting Your Fertility Journey
Navigating fertility and endometriosis involves a multifaceted approach that combines medical care with lifestyle and nutritional support. Emerging research suggests that certain nutrients and dietary approaches may help support your reproductive health if you’re managing endometriosis.
At FertilitySmart, we offer both women's fertility supplements and men's fertility supplements formulated with research-informed nutrients including omega-3 fatty acids, vitamin D, and CoQ10, ingredients discussed in current research on fertility support. Explore our range of fertility supplements formulated to complement your nutritional needs and support nutritional foundations for conception.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
Frequently Asked Questions
Can you get pregnant naturally with endometriosis?
Yes, many women with endometriosis conceive naturally. Research estimates that 60-70% of women with endometriosis can get pregnant without medical intervention. The likelihood depends on factors including the stage and location of endometrial tissue, age, and overall reproductive health.
Does endometriosis get worse over time?
Endometriosis can progress over time in some women, with lesions potentially growing larger or spreading to new areas. However, progression isn't inevitable, some women experience stable disease for years. Regular monitoring with your healthcare provider helps track any changes and adjust treatment as needed.
What stage of endometriosis causes infertility?
Any stage of endometriosis can potentially affect fertility, though the impact generally increases with severity. Women with Stage I or II (minimal to mild) often conceive naturally, while Stage III and IV (moderate to severe) are more likely to involve structural damage to the fallopian tubes and ovaries that significantly reduces fertility.
How is endometriosis-related infertility treated?
Treatment options include hormonal therapy to manage endometrial growth, surgical removal of lesions and adhesions via laparoscopy, and assisted reproductive technologies such as intrauterine insemination (IUI) and in vitro fertilisation (IVF). The best approach depends on the stage of endometriosis, age, and individual fertility factors. Consult your healthcare provider to determine the most appropriate treatment plan for your situation.
Can supplements help with endometriosis and fertility?
Some research suggests that antioxidant and anti-inflammatory nutrients may help support overall reproductive health if you have endometriosis, by reducing oxidative stress and inflammation. Researchers have studied nutrients such as omega-3 fatty acids, vitamin D, and CoQ10 in this context. That said, supplements should complement, not replace, medical treatment. The FDA hasn’t approved supplements to treat endometriosis or infertility. Always consult your healthcare provider before starting any supplement regimen, particularly if you’re taking fertility medications or planning medical procedures.
Does surgery for endometriosis improve fertility?
Surgically removing endometrial lesions and adhesions can improve fertility outcomes, particularly if you have moderate to severe endometriosis. Some studies suggest laparoscopic excision may increase natural conception rates, particularly for milder stages; evidence for moderate to severe disease is less consistent and rests largely on observational data. Results vary depending on disease severity, surgical technique, and individual factors such as age and ovarian reserve.
References
- Alimi, Y., Iwanaga, J., Loukas, M., & Tubbs, R. S. (2018). The Clinical Anatomy of Endometriosis: A Review. Cureus, 10(9), e3361. https://doi.org/10.7759/cureus.3361
- World Health Organisation. (2023, March 24). Endometriosis. World Health Organisation; World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/endometriosis
- Endometriosis and its impact on fertility. Massachusetts General Hospital. (n.d.). https://www.massgeneral.org/obgyn/fertility/treatments-and-services/endometriosis-and-fertility
- Endometriosis, fertility and pregnancy. Endometriosis UK. (n.d.). https://www.endometriosis-uk.org/endometriosis-fertility-and-pregnancy#:~:text=It%20is%20estimated%20that%2060,disease%20distorts%20the%20reproductive%20organs.
- Endometriosis. Fertility Reproductive Medicine Center. (n.d.). https://fertility.wustl.edu/learn/infertility-factors/endometriosis/
- Grandi, G., Ferrari, S., Xholli, A., Cannoletta, M., Palma, F., Romani, C., Volpe, A., & Cagnacci, A. (2012). Prevalence of menstrual pain in young women: What is dysmenorrhea? Journal of pain research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392715/
- Macer, M. L., & Taylor, H. S. (2012, December). Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and gynaecology clinics of North America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/
- Hill, C. J., Fakhreldin, M., Maclean, A., Dobson, L., Nancarrow, L., Bradfield, A., Choi, F., Daley, D., Tempest, N., & Hapangama, D. K. (2020, June 18). Endometriosis and the fallopian tubes: Theories of origin and clinical implications. Journal of clinical medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355596/
- Adenomyosis. Johns Hopkins Medicine. (2022, June 30). https://www.hopkinsmedicine.org/health/conditions-and-diseases/adenomyosis
- Harada, T., Khine, Y. M., Kaponis, A., Nikellis, T., Decavalas, G., & Taniguchi, F. (2016, September). The impact of adenomyosis on women’s fertility. Obstetrical & gynaecological survey. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049976/
- Mohammed Rasheed, H. A., & Hamid, P. (2020, November 16). Inflammation to infertility: Panoramic view on endometriosis. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746006/
- ASRM Practice Committee. Female age-related fertility decline: a committee opinion. Fertility and Sterility, 2014; 101(3): 633-634.
- Treatment options for endometriosis - informedhealth.org - NCBI bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK279498/
Marina Carter
Fertility Health Expert at FertilitySmart
Marina Carter is a specialist health writer with nearly a decade of experience in reproductive health, fertility nutrition, and evidence-based conception support. She has authored over 30 in-depth articles for FertilitySmart, translating peer-reviewed research into clear, practical guidance to support you and your partner on your fertility journey. Read Full Bio →