Endometriosis and Fertility

Endometriosis affects approximately one in ten women of reproductive age and is one of the most common conditions encountered in fertility practice. Whilst many women with endometriosis conceive naturally, the condition is associated with reduced fertility and is present in up to half of women experiencing difficulties conceiving.

At Genus Fertility, we have extensive experience in the management of endometriosis-related infertility. Our approach focuses on understanding how endometriosis may be affecting your fertility, preserving reproductive potential where appropriate, and developing an individualised treatment strategy to maximise your chance of a successful pregnancy.

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Endometriosis and Fertility

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What is Endometriosis-Related Infertility?

Endometriosis occurs when tissue similar to the lining of the womb grows outside the uterus, most commonly affecting the ovaries, fallopian tubes, pelvic lining and surrounding organs.

The impact of endometriosis on fertility is complex and varies significantly between individuals. In some women, fertility is unaffected. In others, endometriosis may contribute to difficulties conceiving through several mechanisms, including:

Distortion of pelvic anatomy due to scar tissue and adhesions
Damage to the fallopian tubes, affecting egg and sperm transport
Endometriosis cysts (endometriomas) affecting ovarian function
Reduced ovarian reserve in some women
Chronic inflammation within the pelvis
Altered egg, sperm and embryo function
Changes within the uterine environment that may affect implantation

The severity of symptoms does not always reflect the severity of the disease. Some women with severe endometriosis have very little pain, whilst others with minimal disease experience significant symptoms.

Symptoms of Endometriosis

Common symptoms of endometriosis include:

Painful periods
Chronic pelvic pain
Pain during sexual intercourse
Pain associated with bowel movements or urination
Bloating and gastrointestinal symptoms
Difficulty conceiving

The exact reason why endometriosis makes it harder to conceive is not fully established. It is likely that scar tissue or inflammation in the fallopian tubes and ovaries creates blockages. It can also alter hormonal balance, disrupting ovulation, and affect embryo implantation.

Diagnosing Endometriosis-Related Infertility

Diagnosis begins with a detailed review of your symptoms, fertility history and previous treatments.

As part of your fertility assessment, we will perform an ultrasound scan to assess the pelvis and ovaries. In some women, endometriosis can be identified on ultrasound through the presence of ovarian endometriomas (endometriosis cysts), which are one of the most common manifestations of the disease.

In certain circumstances, further imaging, such as MRI, may be recommended to provide additional information.

Laparoscopic surgery has been regarded as the gold standard for diagnosing endometriosis and remains the only way to obtain histological confirmation of the disease. However, many women can now be diagnosed based on their symptoms, examination findings and imaging results, without requiring surgery.

For women wishing to conceive, laparoscopy is not routinely performed solely to establish a diagnosis. The potential benefits of surgery must be carefully balanced against the risks, including the possibility of reducing ovarian reserve, particularly where the ovaries are involved.

As part of your fertility assessment, we will also evaluate ovarian reserve, tubal patency and any other factors that may be affecting your ability to conceive.

Treating Endometriosis-Related Infertility

Treatment recommendations depend on your age, symptoms, ovarian reserve, previous treatment history, disease severity, and reproductive goals.

Many women with mild endometriosis will conceive naturally and may not require fertility treatment.

Where fertility treatment is required, options may include:

Expectant management where appropriate
Intrauterine insemination (IUI)
In Vitro Fertilisation (IVF)
Intracytoplasmic Sperm Injection (ICSI)
Fertility preservation through egg or embryo freezing
Surgical treatment in carefully selected patients

Surgery can improve symptoms and may improve fertility in selected circumstances.

However, surgery also carries the risk of reducing ovarian reserve, particularly when endometriosis cysts involve the ovaries. For this reason, decisions regarding surgery should be individualised and made with careful consideration of future fertility plans.

FAQs

Will surgery improve my fertility?

The role of surgery in improving fertility depends on your individual circumstances and is not always straightforward.

For women planning IVF treatment, surgery is not routinely recommended before treatment simply to improve IVF success rates. Whilst surgery may be beneficial in selected circumstances, it can also reduce ovarian reserve, particularly when endometriosis cysts involve the ovaries.

Surgery may be considered where there is significant pain, large endometriosis cysts affecting access to the ovaries during egg collection, uncertainty regarding the diagnosis, or where distortion of pelvic anatomy is thought to be affecting fertility.

Importantly, the timing of treatment requires careful consideration. For some women, symptom control may be the priority. For others, fertility preservation through egg or embryo freezing may be advisable before surgery. In some circumstances, proceeding directly to IVF may offer the greatest chance of pregnancy whilst avoiding the potential impact of surgery on ovarian reserve.

The decision to proceed with surgery should always balance the potential benefits against the possible impact on future fertility. At Genus, we take an individualised approach and will discuss whether symptom management, fertility preservation, fertility treatment, surgery, or a combination of these options is most appropriate for your circumstances.

Can endometriosis affect IVF success rates?

Many women with endometriosis achieve successful pregnancies through IVF. Whilst severe disease may reduce success rates in some circumstances, IVF remains one of the most effective treatment options for endometriosis-related infertility.

The likelihood of success depends on several factors, including age, ovarian reserve, disease severity, and any prior fertility treatment history. These factors will be discussed as part of your personalised fertility assessment.

Do I need treatment if I have endometriosis but no symptoms?

Not necessarily. Treatment decisions should be based on your symptoms, fertility goals, disease severity and ovarian reserve rather than the presence of endometriosis alone.

Some women with endometriosis have no symptoms and conceive naturally without intervention. Others may benefit from fertility preservation, fertility treatment or surgery depending on their individual circumstances.

A personalised assessment can help determine whether treatment is required and whether there are steps you can take to optimise your future fertility.

Should I consider egg freezing if I have endometriosis?

Fertility preservation may be worth considering for some women with endometriosis, particularly those with ovarian endometriomas, disease affecting both ovaries, a reduced ovarian reserve, or those considering ovarian surgery.

Some endometriosis cysts, as well as surgery to treat them, can reduce ovarian reserve. The decision to freeze eggs is highly individual and depends on factors such as age, ovarian reserve, disease severity and future family-building plans.

Endometriosis and Fertility

Endometriosis and Fertility

What is Endometriosis-Related Infertility?

Symptoms of Endometriosis

Diagnosing Endometriosis-Related Infertility

Treating Endometriosis-Related Infertility

FAQs

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