Can You Get Pregnant With Endometriosis? What the Research Actually Says

Can you get pregnant with endometriosis? Yes — most people can. About 60-70% of those with endometriosis conceive without medical help. The remaining 30-40% face fertility challenges that range from minor to significant. This article cuts through the panic and lays out what the research actually shows, when to seek specialist help, and which treatments improve the odds.

For the bigger picture, start with What is Endometriosis?. For symptoms see Endometriosis Symptoms. If you suspect endometriosis is affecting you, the free symptom screener is a useful starting point.

The honest fertility picture

• About 30-50% of people with endometriosis experience fertility challenges (defined as not conceiving after 12 months of trying)
• About 60-70% conceive without medical assistance — sometimes after longer trying periods than average
• Endometriosis is found in ~25-50% of women with infertility who are investigated, but that statistic reflects the medical workup, not the general endo population

Translation: endometriosis is associated with reduced fertility, but the majority of people with endo who want to get pregnant do.

How endometriosis can affect fertility

• Anatomical distortion: adhesions and scarring can change pelvic anatomy, blocking or kinking the fallopian tubes
• Ovarian function impacts: endometriomas (cysts on the ovaries) can reduce ovarian reserve and disrupt ovulation
• Inflammation: chronic pelvic inflammation creates a less hospitable environment for sperm, eggs, and embryo implantation
• Egg quality: some studies suggest reduced egg quality in moderate to severe endometriosis
• Implantation issues: altered uterine receptivity may make embryo implantation harder
• Painful sex (dyspareunia) can mechanically reduce conception chances

Stage matters — stage I-II usually has minimal fertility impact, while stage III-IV may have more significant effects. Individual variation is large.

When to see a fertility specialist

The standard rule of “seek help after 12 months of trying” is too conservative for endometriosis. Updated recommendations:

• If you have known endometriosis: see a specialist after 6 months
• If you have endometriosis and are over 35: consider a specialist after 3 months
• If you have severe endometriosis (stage III-IV) or known endometriomas: consider pre-conception consultation BEFORE trying

Why earlier? Waiting eats into ovarian reserve and reduces fertility-treatment effectiveness. Time matters more in endo than in general fertility care.

Treatment options for fertility

The fertility-focused treatment ladder is different from the pain-focused ladder. Hormonal suppression — the mainstay of pain treatment — is incompatible with trying to conceive.

Laparoscopic surgery to remove endometriotic lesions can improve natural pregnancy rates, especially in stage I-II endometriosis. Evidence is strongest for excision rather than ablation. In severe cases, surgery before IVF may improve outcomes — but the risk of reduced ovarian reserve from ovarian surgery needs careful consideration.

Ovulation induction with clomiphene or letrozole combined with intrauterine insemination (IUI) is sometimes used in mild endometriosis. Success rate is modest.

In vitro fertilization (IVF) is often the most effective option for moderate-to-severe endometriosis. Success rates per cycle are slightly lower than for unexplained infertility, but cumulative success across multiple cycles is high.

See Endometriosis Treatment for the bigger picture.

What about endometriomas?

Endometriomas (ovarian endo cysts) present a specific dilemma. They can reduce ovarian reserve and affect IVF outcomes — but surgical removal also risks reducing ovarian reserve. The decision depends on:

• Size of the endometrioma (typically >4cm is considered for surgery)
• Your age and ovarian reserve markers (AMH, antral follicle count)
• Pain symptoms
• Whether you’re planning IVF or trying naturally
• Surgical history (multiple surgeries compound ovarian reserve loss)

This decision should be made by an endometriosis-specialized surgeon, not a general gynecologist.

During pregnancy and after

Good news: endometriosis symptoms often improve during pregnancy, because pregnancy’s hormonal environment (high progesterone, no menstruation) suppresses endometriotic activity. Many people report their best symptom-free period during pregnancy.

The complicated news: symptoms typically return after weaning. And endometriosis is associated with slightly elevated risks during pregnancy — preterm birth, placenta previa, and miscarriage rates are modestly higher. These risks are manageable with appropriate prenatal care.

Frequently asked questions

Will I be infertile if I have endometriosis?

Most likely not. About 60-70% of people with endometriosis conceive without medical assistance. Severe endometriosis raises fertility challenges substantially, but treatment options (surgery, IVF) make pregnancy possible for many.

Should I get a laparoscopy before trying to conceive?

Not automatically. The decision depends on symptoms, stage, age, and fertility timeline. Surgery improves natural pregnancy rates in stage I-II endometriosis but carries risks (especially for ovarian reserve in ovarian surgery). Discuss with an endometriosis-specialized surgeon who’s also fertility-aware.

Does IVF work well for endometriosis?

IVF is often the most effective option for moderate-to-severe endometriosis. Success rates per cycle are slightly lower than for unexplained infertility, but cumulative success across multiple cycles is high. Many people with stage IV endometriosis conceive successfully via IVF.

Does the pill reduce my fertility long-term?

No. The combined pill (and other hormonal therapies) suppresses endometriosis activity and may even protect ovarian reserve by reducing the formation of new endometriomas. Fertility returns after stopping hormonal therapy.

Will pregnancy cure my endometriosis?

No, but it can provide significant temporary relief. Pregnancy’s hormonal environment suppresses endometriotic activity. Symptoms usually return after weaning. Pregnancy is not a long-term treatment.

Sources

1. European Society of Human Reproduction and Embryology (ESHRE). Endometriosis Guideline. 2022.
2. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril 2012;98:591–598.
3. Vercellini P et al. Endometriosis and the diagnostic iceberg. Lancet 2017;390:331.
4. Macer ML, Taylor HS. Endometriosis and infertility. Obstet Gynecol Clin North Am 2012;39:535–549.