Endometriosis and fertility

Endometriosis is a condition in which tissue similar to the lining of the uterus grows in other places, such as the ovaries, fallopian tubes, and the surrounding tissue. It is common, and its effects range from barely noticeable to significant.

Signs and symptoms

Many people have painful or heavy periods, pelvic pain, or pain during sex. Some have no obvious symptoms at all and only learn they have it while looking into difficulty conceiving. The severity of symptoms does not always match the effect on fertility.

How it affects fertility

Endometriosis can lower the monthly chance of conceiving, for example by distorting the pelvic anatomy with scar tissue, affecting how eggs and sperm move, and in some cases reducing egg quality or ovarian reserve. On average the monthly chance is lower than usual, but it is far from zero, and many people with endometriosis conceive, some naturally and some with help.

Treatment options

The right path depends on the severity, your age, and your wider situation.

• Hormonal treatments help manage pain, but they do not improve fertility and generally pause attempts to conceive while you take them.
• Surgery (usually keyhole, or laparoscopic) can remove endometriosis tissue and adhesions, and for some people this improves the chance of conceiving naturally. It involves a recovery period, so the timing is a real decision.
• IUI, often with medication to encourage ovulation, can help in milder cases.
• IVF is often the most effective route, especially for moderate to severe endometriosis, because it bypasses some of the physical barriers. Where ovarian reserve is a concern, a clinic may suggest collecting and freezing eggs or embryos before surgery.