Trying to conceive can feel exciting, but an endometriosis diagnosis can also raise a difficult question: will endometriosis make getting pregnant harder?
The answer is not simply yes or no. Endometriosis and fertility are closely linked in some women, but endometriosis does not automatically mean infertility. Some women conceive naturally, while others need fertility treatment or carefully planned surgery.
What matters is understanding how endometriosis affects your reproductive system and which factors are relevant to you, including age, ovarian reserve, tubal function, disease location, previous surgery, and your partner’s fertility.
Does Endometriosis Cause Infertility?
Endometriosis can reduce fertility, but infertility is not inevitable; the effect varies according to disease extent, reproductive anatomy, ovarian function, age, and other fertility factors.
A 2026 review reports that infertility affects approximately 30–50% of people with endometriosis, although estimates vary between studies and populations.
The American Society for Reproductive Medicine (ASRM) has also emphasized that the relationship is complex, describing fertility management in endometriosis as involving “complex clinical questions that do not have simple answers.”
So, having endometriosis does not mean you cannot become pregnant. It means your fertility may need closer consideration.
Endometriosis and Fertility Rates: What the Numbers Really Mean
There is no single fertility rate that can accurately predict your chance of pregnancy with endometriosis.
Research measures different outcomes, including natural conception, pregnancy after surgery, IVF pregnancy, and live birth. These figures should not be treated as interchangeable.
ASRM previously reported untreated fecundity estimates of around 2–10% per month in women with endometriosis, compared with roughly 15–20% per month in couples without infertility. The organization also noted that these estimates are difficult to quantify accurately.
The practical message is more useful than any single statistic: your individual fertility outlook depends on much more than whether you have endometriosis.
Why Does Endometriosis Cause Fertility Problems?
Endometriosis fertility problems can involve inflammation, adhesions, altered pelvic anatomy, ovarian endometriomas, and changes in ovarian function and reproductive physiology.
A 2025 review describes endometriosis-associated infertility as the result of interacting anatomical, inflammatory, endocrine, and immune mechanisms rather than one single cause.
Pelvic Inflammation and Reproductive Function
Endometriosis creates a chronic inflammatory environment around the reproductive organs. This may interfere with processes involved in ovulation, fertilization, embryo development, or implantation.
Research has linked endometriosis-related infertility with altered immune responses, oxidative stress, hormonal disturbances, and changes in the local pelvic environment.
In simple terms, inflammation can make an already delicate reproductive process less favorable.
Adhesions and Distorted Pelvic Anatomy
Repeated inflammation can lead to fibrosis and adhesions—bands of scar tissue that may cause the ovaries, fallopian tubes, uterus, or surrounding tissues to stick together or become displaced.
When disease is extensive, this distortion can interfere with the pickup and transport of the egg and with normal reproductive anatomy. A 2026 review describes endometriosis-associated adhesions as an important contributor to infertility.
Ovarian Endometriomas and Ovarian Reserve
Ovarian endometriomas can affect ovarian tissue and are associated with reduced ovarian reserve in some patients.
A recent systematic review found evidence of lower anti-Müllerian hormone (AMH) and antral follicle count in women with endometriosis, particularly those with ovarian endometriomas.
Ovarian reserve does not tell us everything about fertility, but it becomes especially important when an endometrioma or ovarian surgery is part of the discussion.
Why Ovarian Surgery Requires Careful Planning?
Removing an endometrioma may be appropriate in selected cases, but surgery can also affect healthy ovarian tissue.
A systematic review and meta-analysis found a significant postoperative decline in AMH after ovarian endometrioma cystectomy. More recent research continues to emphasize the importance of preserving ovarian reserve when planning endometrioma surgery.
The question, therefore, is not simply whether a cyst can be removed, but whether surgery’s expected benefits outweigh its reproductive risks.
Is It Hard to Get Pregnant With Endometriosis?
Getting pregnant with endometriosis can be harder for some women, but the diagnosis alone cannot tell you whether natural conception will be easy, difficult, or unlikely.
NICE’s 2026 fertility guideline recommends considering the length of time trying, endometriosis symptoms and severity, age, ovarian reserve, and male-factor fertility issues when deciding on management.
That helps explain why two women with endometriosis can have completely different fertility experiences.
Can You Have Kids With Endometriosis?
Yes, you can have kids with endometriosis.
Natural pregnancy is possible, even though some women need fertility support. A multicenter prospective study of women with endometriosis found that natural conception accounted for 70% of conceptions among those who became pregnant during the study period, although the overall cohort’s conception rate was much lower and individual outcomes varied.
So, endometriosis should not be viewed as a verdict on your ability to become a parent.
Does the Stage of Endometriosis Predict Fertility?
Not perfectly.
Endometriosis Stage I–IV classification describes the extent of endometriosis, but it does not function as a precise personal fertility score. Research has found that disease stage may influence some assisted-reproduction outcomes, yet fertility also depends on age, ovarian reserve, anatomy, and other factors.
A study evaluating natural pregnancy after endometriosis surgery found that the Endometriosis Fertility Index (EFI) predicted natural pregnancy better than rAFS stage in that cohort.
In other words, stage tells us about disease—not your entire fertility future.
How Is Fertility Evaluated When You Have Endometriosis?
A fertility assessment looks beyond the diagnosis to determine whether the ovaries, tubes, uterus, ovulation, or sperm factors may be affecting your chance of conception.
The goal is to find the factors that can actually be addressed rather than assuming endometriosis explains everything.
Ovarian Reserve, Ultrasound, and Tubal Testing
Depending on the situation, evaluation may include ovarian-reserve testing, pelvic ultrasound, assessment of ovulation, and testing of the fallopian tubes.
Ultrasound is particularly useful for identifying ovarian endometriomas and can contribute to evaluation of deep endometriosis. NICE recommends specialist ultrasound or pelvic MRI when deep disease is suspected, with imaging interpreted by appropriately experienced professionals.
Why Your Partner’s Fertility Matters Too?
Fertility involves both partners. Endometriosis may be present, but male-factor infertility can also contribute to difficulty conceiving.
NICE specifically recommends considering male-factor fertility issues alongside age, ovarian reserve, disease severity, and time trying to conceive.
A complete assessment can therefore prevent unnecessary delays and reveal more than one factor affecting pregnancy.
Endometriosis and Fertility Treatment: What Are Your Options?
Endometriosis and fertility treatment should be individualized; the right path depends on age, ovarian reserve, disease severity, pelvic anatomy, previous treatment, and how long you have been trying.
The updated NICE guideline gives clinicians several options, including expectant management, surgery, IUI, and IVF, depending on the individual circumstances.
Trying to Conceive Naturally
Natural conception may be reasonable when there is no major anatomical distortion, significant tubal disease, or other fertility factor requiring quicker intervention.
NICE currently recommends discussing expectant management for up to two years in appropriate people with endometriosis, including the time already spent trying before assessment.
However, waiting is not necessarily appropriate for everyone, especially when age, ovarian reserve, severe disease, or other fertility factors make time more important.
IUI and IVF
IUI places prepared sperm into the uterus around ovulation, while IVF involves retrieving eggs, fertilizing them outside the body, and transferring an embryo.
Under NICE’s 2026 recommendations, up to four cycles of IUI with ovarian stimulation may be considered in appropriate cases before IVF, while IVF can be offered when it is more suitable.
IVF is not automatically necessary just because you have endometriosis.
When Can Endometriosis Surgery Help Fertility?
Surgery can be useful when endometriosis causes significant adhesions, anatomical distortion, endometriomas, or other clinically important disease.
However, surgery before IVF is not automatically beneficial. A 2024 systematic review and meta-analysis found no significant improvement in live birth or ongoing pregnancy rates when surgery was performed before IVF/ICSI compared with first-line IVF/ICSI.
A newer 2026 meta-analysis similarly found no significant improvement in live birth after surgery before IVF/ICSI for ovarian or deep endometriosis, while ovarian surgery was associated with reductions in AMH and retrieved oocytes in the endometrioma group.
Fertility-Sparing Surgery for Endometriomas and Deep Endometriosis
When surgery is appropriate, fertility preservation should be part of the planning from the beginning.
This is especially important for ovarian endometriomas, where removing disease must be balanced against preserving healthy ovarian tissue. For deep endometriosis, the location of disease and involvement of structures such as the bowel, bladder, or ureters may also influence the surgical approach.
At Dr. Lucas Minig’s practice in Valencia, endometriosis surgery includes laparoscopic treatment of ovarian endometriomas, deep endometriotic lesions, and pelvic adhesions, with selected procedures involving the bowel, bladder, or ureter when clinically indicated. His service also describes fertility-focused surgical planning and minimally invasive treatment.
When Should You Seek Fertility Help?
Earlier assessment can be useful when endometriosis affects the ovaries, tubes, or deep pelvic structures, or when age and ovarian reserve make delaying fertility decisions less desirable.
You may benefit from specialist advice if you have an endometrioma, deep endometriosis, previous ovarian surgery, suspected tubal problems, reduced ovarian reserve, or difficulty conceiving.
NICE recommends basing decisions on the time trying to conceive, age, symptoms and severity, ovarian reserve, and male-factor fertility issues, rather than using one fixed approach for everyone.
Endometriosis, Fertility Preservation, and Planning Ahead
Fertility planning can be valuable before pregnancy becomes an immediate goal, particularly when endometriosis affects the ovaries or repeated treatment may be required.
This does not mean every woman with endometriosis needs fertility preservation. Instead, it means understanding your reproductive timeline and discussing options when appropriate.
A 2026 systematic review highlights the need for individualized fertility-preservation counselling because both endometriosis and some surgical treatments may affect ovarian reserve.
Getting Specialist Endometriosis Care in Valencia, Spain
For women with complex endometriosis and fertility concerns, specialist care can bring disease mapping, fertility priorities, and surgical planning together rather than treating each issue separately.
Dr. Lucas Minig’s Valencia practice focuses on complex gynecological surgery and reports that more than 95% of its complex procedures use minimally invasive laparoscopic or robotic techniques. Its endometriosis service includes endometrioma surgery, deep lesion excision, adhesiolysis, and selected bowel, bladder, and ureteral procedures.
For someone dealing with endometriosis and fertility problems, the important goal is not simply removing disease. It is finding the right balance between symptom control, safe treatment, preservation of ovarian function, and the chance of future pregnancy.
Conclusion
Endometriosis and fertility problems can be closely connected, but an endometriosis diagnosis does not mean you cannot have children. Inflammation, adhesions, endometriomas, distorted anatomy, and reduced ovarian reserve can affect fertility, but their impact varies from one woman to another.
The better question is not simply “Does endometriosis cause infertility?” but “How is my endometriosis affecting my fertility, and what approach gives me the best chance of pregnancy without unnecessary risk?” A personalized evaluation can help answer that question.
Frequently Asked Questions
Can endometriosis cause infertility even if I have mild disease?
Yes. Mild endometriosis can be associated with reduced fertility, although its exact effect is difficult to predict. Age, ovarian reserve, tubal function, and sperm quality also matter.
Can you get pregnant naturally with endometriosis?
Yes. Many women with endometriosis conceive naturally. However, the probability varies according to disease characteristics and other fertility factors, so population statistics cannot predict an individual’s outcome.
Does endometriosis surgery improve fertility?
It can improve the chance of natural pregnancy in selected patients, particularly when adhesions or anatomical distortion are present. However, surgery before IVF does not consistently improve live birth rates, and ovarian surgery can reduce ovarian reserve.
Is IVF always necessary with endometriosis?
No. Natural conception, expectant management, surgery, IUI, and IVF may all have a role depending on the individual situation. NICE recommends choosing treatment according to age, ovarian reserve, disease severity, time trying, and other fertility factors.
Should I have my ovarian reserve tested if I have endometriosis?
It may be particularly useful when you have an ovarian endometrioma, previous ovarian surgery, or are considering treatment that could affect ovarian tissue. However, ovarian reserve is only one part of fertility assessment.
