Endometriosis is a chronic condition that affects approximately 1 in 10 women of reproductive age. For many of these women, this diagnosis raises a crucial question: how does endometriosis affect fertility? 

In this article, we’ll explore the **connection between endometriosis and fertility**, discuss natural and medical treatment options, and look at what the evidence says about pregnancy outcomes, including after surgery or IVF.

Whether you're trying to understand how to conceive naturally with endometriosis or looking into assisted reproductive options like IVF, this comprehensive guide will help you make informed decisions.

## Understanding endometriosis and fertility problems

Fertility problems associated with endometriosis are multifaceted. Alongside physical barriers like adhesions and blocked fallopian tubes, chronic pelvic inflammation may compromise implantation even if fertilisation occurs. In more severe cases, ovarian function is reduced, both in terms of egg quantity and quality.

Even in mild cases, fertility may be subtly impaired. This means early detection and a comprehensive, multidisciplinary management plan are essential.

## Can you get pregnant if you have endometriosis?

Yes, it is possible to get pregnant with endometriosis, but the journey may be more complex. It’s estimated that up to [50%](https://www.massgeneral.org/obgyn/fertility/news/endometriosis-and-its-impact-on-fertility) of women with endometriosis experience fertility problems. This is due to several mechanisms:

- **Inflammation** caused by endometriosis can interfere with ovulation and implantation.
- **Adhesions and endometriomas** (ovarian cysts) may block or distort the fallopian tubes and ovaries.
- **Hormonal imbalances**, particularly oestrogen dominance, can impair egg quality and implantation.
- **Reduced ovarian reserve**, especially in more severe stages, may lower fertility rates.

A [2023 systematic review](https://pubmed.ncbi.nlm.nih.gov/36948440/) confirms that women with endometriosis are more likely to experience delayed conception and require fertility treatment compared to those without the condition.

## The impact of endometriosis stage on fertility

Endometriosis is classified into four stages: minimal (Stage I), mild (Stage II), moderate (Stage III), and severe (Stage IV). The classification is based on factors such as lesion size, depth, and the extent of pelvic adhesions and ovarian endometriomas.

- **Stage I–II (Minimal to Mild)**: Fertility may still be affected, especially due to inflammation and subtle pelvic adhesions. However, many women in these stages can conceive naturally with minimal intervention.
- **Stage III–IV (Moderate to Severe)**: These stages are associated with more extensive tissue damage, ovarian cysts, and distorted reproductive anatomy. Women at this level are more likely to require fertility treatment such as laparoscopic surgery or IVF.

According to [Mass General Fertility Center](https://www.massgeneral.org/obgyn/fertility/news/endometriosis-and-its-impact-on-fertility), advanced-stage endometriosis often leads to reduced ovarian reserve and disrupted tubal-ovarian function, significantly lowering fertility rates.

## How can I improve my fertility with endometriosis?

Improving fertility with endometriosis often requires a personalised, multi-layered approach that may include lifestyle changes, medical treatment, and/or assisted reproductive technologies. Here’s what you can do:

### 1. Address inflammation through diet and lifestyle

Since endometriosis is an inflammatory condition, adopting an anti-inflammatory diet can help reduce symptoms and support fertility. Focus on:

- **Whole foods**: fruits, vegetables, oily fish, legumes, and whole grains.
- **Antioxidants**: found in colourful plant foods and green tea.
- **Omega-3 fatty acids**: from flaxseed, chia, walnuts, and fatty fish.
- **Limiting red meat, trans fats, and processed foods**, which may exacerbate inflammation.

A [2024 meta-analysis](https://pubmed.ncbi.nlm.nih.gov/39358652/) showed that an anti-inflammatory diet may play a role in reducing pain and improving quality of life in women with endometriosis, which could indirectly support better reproductive outcomes.

### 2. Explore acupuncture and stress reduction

Chronic stress can exacerbate endometriosis symptoms and reduce fertility. Practices such as acupuncture, yoga, mindfulness, and regular gentle exercise may support hormonal regulation and reduce inflammation.

### 3. Laparoscopy

For some women, especially those with moderate to severe endometriosis or anatomical complications, surgery may be recommended. Laparoscopic excision surgery can remove endometrial implants, adhesions, and cysts, improving fertility outcomes.

A [2023 meta-analysis](https://pubmed.ncbi.nlm.nih.gov/37587520/) confirms that surgical removal of endometriomas is associated with improved spontaneous pregnancy rates post-procedure.

### 4. Hormonal medication

Although hormonal medications like **birth control pills** and **GnRH agonists** (such as leuprolide acetate) are not suitable while actively trying to conceive, they can be valuable tools in managing symptoms and suppressing disease progression before fertility-focused treatments begin.

- **Birth control pills**: These suppress ovulation and reduce oestrogen levels, which helps control pain and slow disease progression. While they delay conception, they can be used to manage symptoms before attempting pregnancy.
- **GnRH agonists**: These drugs induce a temporary menopause-like state by lowering oestrogen levels. They’re sometimes used before IVF or after surgery to help reduce inflammation and improve treatment outcomes. However, they are not a long-term solution for those actively trying to conceive due to their ovulation-suppressing effects.

### 5. Assisted reproductive technologies

If natural methods and surgery are unsuccessful, assisted reproductive technologies (ART) such as **in vitro fertilisation (IVF)** can help.

#### IVF and endometriosis

IVF is a commonly recommended treatment when other fertility strategies have not worked. The good news is that IVF success rates for women with endometriosis are generally positive, especially when the condition is managed effectively beforehand.

However, [some studies](https://pubmed.ncbi.nlm.nih.gov/25560108/) suggest that **endometriosis may reduce IVF success rates** compared to women with other fertility diagnoses. This is likely due to compromised egg quality, chronic inflammation, and lower ovarian response to stimulation.

Still, IVF can be a highly effective path to pregnancy, particularly in combination with prior surgical intervention or hormone management. Individual results will depend on:

- Age
- Ovarian reserve
- Stage of endometriosis
- Overall health

If you’re exploring IVF, consider working with a fertility clinic experienced in managing **IVF and endometriosis** cases for tailored treatment plans.

## How to conceive naturally with endometriosis

While some women may need IVF or surgery, others can conceive naturally—even with a diagnosis of endometriosis. Here’s how to maximise your chances:

- **Track your cycle** carefully to identify ovulation and fertile windows.
- **Adopt an anti-inflammatory diet** and support hormone balance.
- **Address gut health**, which plays a role in both hormone detoxification and immune function.
- **Consider fertility-focused supplements** like CoQ10 and NAC.
- **Reduce stress** to support hormonal health.
- **Work with a fertility specialist** who understands endometriosis.

Importantly, **pregnancy after endometriosis surgery** is possible and often successful, especially when combined with positive lifestyle changes.

## When to seek help

If you’ve been trying to conceive for 6–12 months (depending on age) without success—and especially if you have known endometriosis—it’s advisable to consult a fertility specialist. Early intervention can help identify and address any barriers, improving your chances of conceiving sooner.

## Taking control of your fertility journey with endometriosis

Endometriosis and fertility are closely linked, but a diagnosis does not mean you won’t get pregnant. With the right strategies—including diet, hormone balancing, supplements, surgery, or assisted reproductive technology—many women go on to have successful pregnancies.

Crucially, not every woman with endometriosis experiences fertility challenges. The condition affects everyone differently, and early diagnosis, education, and a holistic approach can make a significant difference.

Whether you’re considering **how to get pregnant with endometriosis naturally** or navigating **IVF and endometriosis**, know that support and solutions are available.

This video delves into how endometriosis can affect fertility, explaining the condition's impact on reproductive health and offering insights into potential treatment options and coping strategies for those trying to conceive

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The Link Between Endometriosis and Fertility

The Link Between Endometriosis and Fertility