Endometriosis and Fertility: What Every Woman Should Know
Endometriosis is a common gynaecological condition that affects approximately one in nine Australian women by the age of 44. For some, it causes significant pelvic pain. For others, difficulty conceiving may be the first sign that something is wrong.
A frequent question I am asked in practice is:
Can endometriosis affect my fertility?
The answer is yes, it can. However, the degree of impact varies significantly between individuals. Many women with endometriosis conceive naturally. Others may require medical or surgical treatment.
This article explains how endometriosis affects fertility, when to seek specialist advice, and what treatment options are available.
What is endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. These deposits are most commonly found on:
The ovaries
The fallopian tubes
The outer surface of the uterus
The pelvic lining
The bowel or bladder
This tissue responds to hormonal changes during the menstrual cycle. Unlike the uterine lining, however, it has no natural way to exit the body. Over time, this can lead to inflammation, scarring and adhesions.
The severity of symptoms does not always correlate with the extent of disease. Some women with mild endometriosis experience severe pain, while others with more extensive disease may have minimal symptoms.
How can endometriosis affect fertility?
Endometriosis can interfere with fertility in several ways.
1. Distortion of pelvic anatomy
Scar tissue and adhesions may alter the normal relationship between the ovaries and fallopian tubes. This can make it more difficult for the egg and sperm to meet.
2. Inflammation
Endometriosis is associated with chronic inflammation within the pelvis. This inflammatory environment may affect egg quality, fertilisation and implantation.
3. Ovarian reserve
Endometriosis affecting the ovaries, known as endometriomas, may reduce ovarian reserve over time. Surgical treatment can also impact ovarian reserve if not carefully planned.
4. Impaired implantation
There is some evidence that endometriosis may affect the uterine environment and implantation, although the mechanisms are still being studied.
It is important to note that the impact on fertility varies. Some women with advanced endometriosis conceive without difficulty, while others with mild disease may experience challenges.
What are the symptoms of endometriosis?
Common symptoms include:
Painful periods
Pain during intercourse
Chronic pelvic pain
Pain with bowel movements during menstruation
Heavy menstrual bleeding
Fatigue
However, some women have minimal or no symptoms and only discover endometriosis during fertility investigations.
When should you see a specialist?
You should consider specialist assessment if:
You have symptoms suggestive of endometriosis
You have been trying to conceive for 12 months without success
You are over 35 and have been trying to conceive for 6 months
You have known endometriosis and are planning pregnancy
You have had previous pelvic surgery
Early assessment can help clarify the diagnosis and guide appropriate management.
How is endometriosis diagnosed?
A detailed clinical history is essential. Pelvic ultrasound can identify ovarian endometriomas and sometimes deep infiltrating disease. However the ultrasound diagnosis of endometriosis has improved significantly over the last several years.
However, mild endometriosis may not be visible on imaging. The only definitive way to diagnose endometriosis is through laparoscopy, a minimally invasive surgical procedure that allows direct visualisation and treatment.
Not all women require surgery for diagnosis. The decision depends on symptoms, fertility goals and imaging findings.
Do you need surgery before trying to conceive?
This is a common and important question.
Surgery may be recommended if:
There is significant pelvic pain
There are large ovarian endometriomas
Pelvic anatomy appears distorted
There is suspicion of advanced disease
However, surgery is not always necessary before fertility treatment. In some cases, proceeding directly to ovulation induction or IVF may be more appropriate.
The decision depends on:
Age
Duration of infertility
Ovarian reserve
Severity of disease
Previous treatment history
Management should be individualised rather than routine.
Fertility treatment options for endometriosis
Treatment depends on the severity of disease and the couple’s circumstances.
Ovulation induction
For women with minimal or mild endometriosis and irrregular ovulation, ovulation induction with timed intercourse may be considered.
Intrauterine insemination
In selected cases, intrauterine insemination may be appropriate, particularly in mild disease.
In vitro fertilisation
IVF is often recommended for moderate to severe endometriosis or when other treatments have been unsuccessful. IVF bypasses some of the mechanical barriers caused by pelvic scarring.
Success rates depend on age and ovarian reserve.
Combined surgical and fertility approach
In some cases, surgery followed by fertility treatment may offer the best outcome. This requires careful planning to balance symptom relief and preservation of ovarian function.
Does endometriosis always cause infertility?
No. Many women with endometriosis conceive naturally. The presence of endometriosis does not automatically mean infertility.
However, if pregnancy has not occurred after an appropriate period of trying, further assessment is warranted.
Time is an important factor, particularly for women in their mid to late thirties.
Long term considerations
Endometriosis is a chronic condition. Management focuses on:
Symptom control
Fertility planning
Preventing progression where possible
For women not currently planning pregnancy, hormonal treatments may be used to suppress disease activity. For those planning a family, fertility preservation discussions may be appropriate in some cases.
When to seek fertility advice in Sydney
If you are experiencing symptoms of endometriosis or difficulty conceiving, early specialist advice can clarify:
Whether endometriosis is likely contributing
Whether further imaging or laparoscopy is appropriate
The most suitable fertility pathway
Whether IVF should be considered
Individual assessment allows treatment decisions to be based on your age, ovarian reserve and overall reproductive goals.
About Dr Greg Jenkins
Dr Greg Jenkins is a specialist obstetrician and gynaecologist and Head of Obstetrics and Gynaecology at Westmead Public Hospital. He provides obstetric, fertility and gynaecological care in Western Sydney and delivers at Norwest Private, Westmead Private and Westmead Public Hospitals.
Appointments: 02 8805 7900
