Endometriosis and Fertility

Understanding Endometriosis and Its Impact on Fertility

Endometriosis is a common condition that affects up to 1 in 10 people of reproductive age, and it can have a significant impact on fertility. Many people live with endometriosis for years before getting a diagnosis — but with the right care and treatment, pregnancy is absolutely possible.

1. What Is Endometriosis?

Endometriosis happens when tissue similar to the lining of the uterus (the endometrium) grows outside the uterus — often on the ovaries, fallopian tubes, or pelvic lining.

Each month, this tissue responds to hormonal changes just like the uterine lining does — it thickens, breaks down, and bleeds. But because it’s outside the uterus, it has nowhere to go, leading to inflammation, scar tissue, and pain.

These changes can make it harder for eggs to travel through the fallopian tubes or for embryos to implant, which may affect fertility.

2. What Are the Symptoms?

Endometriosis can look different for everyone. Some people have severe pain, while others have few or no symptoms.Common signs include:

• Painful periods (often worse than usual)

• Pain during sex or after intercourse

• Pelvic pain outside of menstruation

• Heavy or irregular bleeding

• Bloating, fatigue, or digestive discomfort

• Difficulty getting pregnant

Because symptoms can overlap with other conditions, it can take time to reach a diagnosis — but early evaluation helps protect fertility and reduce pain.

3. How Is Endometriosis Diagnosed?

Endometriosis can be suspected based on symptoms, imaging, and medical history, but a definitive diagnosis is usually made through laparoscopy — a minimally invasive surgical procedure that allows doctors to see and sometimes remove endometrial tissue.

Other common tests may include:

• Ultrasound: To look for ovarian cysts (endometriomas)

• MRI: To assess deeper endometrial lesions

• Blood tests: To check hormone levels or inflammation markers

  
  

🧪 Test Values Explained: Hormone and Fertility Markers in Endometriosis

Test	What It Measures	Typical Findings in Endometriosis	Typical Range
CA-125	Inflammation marker	Often elevated in moderate to severe endometriosis	<35 U/mL (normal)
AMH (Anti-Müllerian Hormone)	Ovarian reserve	May be lower if endometriosis affects the ovaries	1.5–4.0 ng/mL (normal)
FSH (Follicle-Stimulating Hormone)	Ovarian function	Can be elevated if reserve is low	<10 mIU/mL (normal)
Estradiol (E2)	Estrogen levels	Often normal or high	30–80 pg/mL on day 3
Ultrasound Findings	Ovarian cysts (endometriomas)	Cysts with thick fluid or “chocolate cysts”	—

➡️ No single test can confirm endometriosis, but these results help your care team understand how it may be affecting your fertility and ovarian health.

4. How Endometriosis Affects Fertility

Endometriosis can make conception more difficult in several ways:

• Blocked fallopian tubes: Scar tissue can prevent eggs and sperm from meeting.

• Inflamed pelvic environment: May affect egg quality or implantation.

• Ovarian damage: Endometriomas can reduce the number of healthy eggs.

• Hormonal disruption: Can interfere with normal ovulation.

However, the degree of fertility impact varies — some people with mild endometriosis conceive naturally, while others may need assistance.

5. Treatment and Fertility Options

Treatment for endometriosis depends on symptoms, age, and fertility goals.

💊 Medical Management

• Hormonal therapies (birth control pills, progestins, or GnRH analogs) can reduce pain and inflammation.

• Pain management with anti-inflammatory medications can improve quality of life.

🌱 Surgical Treatment

• Laparoscopic excision or ablation can remove endometrial lesions and scar tissue, improving fertility for many patients.

• Surgery is often most effective for moderate to severe endometriosis.

🌼 Fertility Treatments

• Ovulation induction or IUI: Helpful when mild endometriosis is present and tubes are open.

• In vitro fertilization (IVF): Often recommended for moderate to severe cases, especially if other treatments haven’t worked. IVF can help bypass the effects of scar tissue or blocked tubes.

  
  

6. What to Expect During IVF with Endometriosis

During IVF, eggs are retrieved and fertilized in the lab to create embryos. This process helps overcome many barriers caused by endometriosis.

Your care team may adjust medication doses or use specific stimulation protocols if ovarian reserve is affected. In some cases, removing large cysts or treating inflammation before IVF can improve success rates.

💗 The Takeaway:

Endometriosis can make the path to pregnancy more complex—but not impossible. With early diagnosis, compassionate care, and a personalized fertility plan, many people with endometriosis achieve healthy pregnancies through natural conception or assisted reproductive technologies like IVF.

If you experience painful periods or have struggled to conceive, don’t wait to seek evaluation. Understanding your symptoms is the first step toward healing and hope.