Illustration of uterus and ovaries to highlight endometriosis and fertility

Understanding the relationship between endometriosis and fertility

Medically reviewed on August 1, 2022 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Infertility can have many causes [1]. Some common reasons you may have trouble getting pregnant can include untreated infections, poor egg quality, the shape of your uterus, or certain health conditions. One such health problem that can interfere with fertility is endometriosis.

Endometriosis is a debilitating condition that causes severe pain and discomfort. Along with the painful physical symptom/s, endometriosis can also act behind the scenes to harm your chances of becoming pregnant.

This guide will walk you through everything you need to know about the endometriosis fertility problem link. It will also help you better understand your options for treatment to improve your ability to become pregnant.

What is endometriosis?

Endometriosis is a condition where tissue that should normally grow inside of your uterus grows outside of the uterus instead. Some common places the endometriosis tissue grows include [2]:

  • On your fallopian tubes
  • The lining of your pelvis
  • On your bladder
  • In abdominal surgery scars
  • On your ovaries
  • Outside of your uterus
  • On your intestines

When this specific type of tissue grows where it doesn’t belong, it can be very painful. This is because it is the same type of tissue that lines your uterus. When you menstruate each month, your uterus sheds that tissue and you bleed. The tissue in places other than your uterus can follow the same shedding process, leading to extreme pain and discomfort.

What are the symptoms of endometriosis?

Endometriosis is also very common. It’s estimated that as many as five million people in the United States may suffer from endometriosis [2]. It can affect you at any age, although the most commonly diagnosed age groups are people in their thirties and forties. Those who have short menstrual cycles, haven’t had children, and have a family member with endometriosis are more likely to have the condition.

Some of the common symptoms associated with endometriosis include:

  • Extremely intense and painful cramps around your period
  • Heavy bleeding during your period
  • Spotting between periods
  • Pain while peeing or having a bowel movement
  • Frequent lower back or stomach pain
  • Pain or discomfort during vaginal intercourse

However, some people don’t experience severe symptoms. Others don’t have any symptoms at all. Regardless of the severity (or lack thereof) of your symptoms, you may be at greater risk for infertility if you suffer from endometriosis.

Why can endometriosis lead to infertility?

There are several reasons endometriosis can lead to infertility. When the excess tissue grows where it shouldn’t, complications follow, such as [2]:

  • Endometriosis can lead to scar tissue – When your body tries to shed the excess tissue that has grown outside of your uterus, it bleeds. However, there isn’t anywhere for the blood to go to escape your body. Instead, it causes swelling which eventually leads to the development of scar tissue.
  • Scar tissue can block the release of eggs from your ovaries – That scar tissue can make it difficult or impossible for your ovaries to release eggs during ovulation. The scar tissue can block your fallopian tubes as well. Without a viable egg, fertilization and pregnancy cannot occur.
  • Scarring can damage the uterine lining – Finally, the scar tissue caused by endometriosis can damage the uterine lining. This may make it difficult or impossible for a fertilized egg to implant and become a viable pregnancy.

How much harder is it to get pregnant if you have endometriosis?

Endometriosis has been shown to contribute to infertility in many people. Unfortunately, it’s very difficult to pinpoint the exact breadth of endometriosis’s impact on fertility.

However, some research suggests that as many as 25% to 50% of infertile women also have endometriosis [3]. And it’s estimated that between 30% to 50% of those who suffer from endometriosis are infertile.

The good news is that certain treatments can improve your quality of life and relieve some symptoms of endometriosis. Other treatment options may help improve your ability to become pregnant.

What treatment options are available for endometriosis?

The available endometriosis treatment options can be divided into two categories: those that can make you more comfortable and those that may improve your chances of getting pregnant. The right endometriosis treatment option for you depends on several factors, including:

  • Your age and overall health
  • The severity of your endometriosis
  • If you do or don’t wish to become pregnant

Let’s take a closer look at some of the options that might be available, depending on your situation.

Treatments to improve quality of life with endometriosis

There are three main treatments for improving the quality of life for those who suffer from endometriosis. These treatments may or may not have a direct impact on fertility. Instead, the focus is on relieving some of the symptoms. Your chosen endometriosis treatment option might include [4]:

  • Pain medication – For those who suffer from more mild endometriosis symptoms, over-the-counter pain medications, such as NSAIDs, might provide the necessary relief. If your symptoms are more severe, a prescription strength painkiller might help.
  • Hormonal contraceptives – Many people also use hormonal contraception to help control some of the pain and discomfort caused by endometriosis. Often, oral contraceptives help make your period shorter and lighter. This may mitigate some of your endometriosis symptoms. Some individuals may take extended-cycle birth control pills that allow them to skip menstruation for several months at a time. Planning on having kids in the future and wondering "Does birth control affect fertility?" The good news is it won’t.
  • Menstrual suppression medication – Outside of extended-cycle birth control, other medications can suppress menstruation. Progesterone can be taken in pill form or injected to stop your period. Danazol is another medication that stops your body from releasing the hormones needed for menstruation. Finally, the Gonadotropin-releasing hormone (GnRH) can also stop the production of hormones that lead to ovulation and menstruation.
  • Hysterectomy – In very severe cases of endometriosis, certain individuals may opt for a hysterectomy. In a hysterectomy, your uterus and cervix are removed. Your ovaries and fallopian tubes may also be taken out. A hysterectomy involves major surgery and is usually only used as a last resort treatment for endometriosis.

Treatments to improve fertility with endometriosis

Many individuals with endometriosis may have trouble getting pregnant. When this happens, there are two routes typically used to increase the likelihood that they will be able to get pregnant. These include [4]:

  • Minimally invasive surgical treatment – The first step to improve fertility in those with endometriosis-related complications is to perform a laparoscopy. This minimally invasive endometriosis surgery involves inflating the abdomen and using a combination of a small light and surgical tools to remove the growths and scar tissue caused by endometriosis. This process is most successful for those who have more moderate, rather than severe, endometriosis.
  • In vitro fertilization (IVF) – If laparoscopy isn’t effective, your doctor might suggest IVF. In IVF, your eggs are fertilized with sperm in a laboratory environment. They’re then returned to your uterus where they attempt to implant and become a viable embryo. IVF isn’t always successful, however, and can come with some complications. It’s also very expensive, making it the last-chance option for many who are trying to become pregnant. So, be sure to familiarize yourself with symptoms of failed implantation of a fertilized egg.

It’s also important to know that endometriosis can make certain pregnancy complications more likely. Those who suffer from endometriosis are at a higher risk for [5]:

  • Miscarriage
  • Preterm births
  • Placenta previa
  • Babies with low birth weights

Keep in mind that not all those who have endometriosis will have complications. It’s just something to be aware of and discuss with your doctor.

What other conditions impact fertility?

Finally, while endometriosis is a frequent culprit when it comes to fertility problems, it’s certainly not the only cause. Some other conditions that can impact your ability to become pregnant may include: [6]

  • Scarring as a result of surgical procedures
  • Uterine fibroids or polyps
  • A misshapen uterus
  • Untreated STD infections or HPV
  • Polycystic Ovarian Syndrome (PCOS) or Primary Ovarian Insufficiency (POI)
  • Autoimmune diseases
  • Obesity or low body weight
  • Age
  • Smoking or excessive alcohol use
  • Hormonal problems
  • Thyroid disorders
  • Menstruation irregularities
  • Failure to ovulate or poorly developed eggs

This is by no means an exhaustive list of potential causes of infertility. If you’ve been trying to get pregnant for at least a year without success, you should speak with a healthcare professional about the potential underlying causes of infertility.

Get a clearer picture of your fertility levels with Everlywell

Endometriosis is a debilitating condition that can interfere with fertility. The cysts, adhesions, and scarring left behind by the condition can impair your ovaries’ ability to release eggs during ovulation. Scarring in the uterine lining may also prevent the implantation of fertilized eggs, resulting in an inability to maintain a viable pregnancy. Treatments do exist to improve both the quality of life and the ability to get pregnant in those who have endometriosis.

However, endometriosis isn’t the only cause of fertility problems. If you don’t have endometriosis but are still having trouble getting pregnant, then your hormones might be the culprit. The Everlywell Women’s Fertility Test measures specific hormones that can influence your fertility. This simple, at-home test can give you some helpful insight into your body so that you can make informed decisions about where to go next.

Try our test today and take control of your reproductive health.

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  1. Infertility. Planned Parenthood. URL. Accessed August 1, 2022.
  2. Endometriosis. Planned Parenthood. URL. Accessed August 1, 2022.
  3. Endometriosis and Infertility. PubMed. URL. Accessed August 1, 2022.
  4. What Are the Treatments for Endometriosis? NIH. URL. Accessed August 1, 2022.
  5. Lim HJ, Sun J, Min B, et al. Endometriosis and Adverse Pregnancy Outcomes: A Nationwide Population-Based Study. J Clin Med. 2023;12(16):5392. Published 2023 Aug 19. doi:10.3390/jcm12165392
  6. Possible Causes of Female Infertility. NIH. URL. Accessed August 1, 2022.
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