Explore how endometriosis impacts fertility and how to recognize the signs of this often misunderstood condition. Endometriosis affects an estimated 1 in 10 women of reproductive age, yet it often goes undiagnosed for years.
How does endometriosis affect fertility?
Endometriosis can make it much more difficult to get pregnant. In fact, 25–50% of all infertile women have endometriosis, making it a prevalent issue in reproductive health.
One of the main ways endometriosis affects fertility is through scar tissue formation. When endometrial tissue grows outside the uterus, it can create scar tissue, adhesions, and inflammation around the ovaries and fallopian tubes. This can often distort the normal anatomy of the pelvis, making it harder for the fallopian tubes to move over to the ovary and pick up the egg during ovulation.
Endometriosis can also interfere with ovulation. Endometriomas, cysts formed by endometriosis growing deep within the ovaries, can disrupt ovulation by affecting both the development and/or release of eggs — and can reduce ovarian reserve, making conception more difficult. Additionally, some research suggests endometriosis can negatively affect egg quality due to the inflammatory environment it creates within the pelvis.
Another concern is embryo implantation. The inflammation caused by endometriosis can make it more difficult for the embryo to successfully implant within the uterine endometrial lining, leading to infertility or recurrent pregnancy loss.
The severity of endometriosis plays a significant role in its impact on fertility:
- Stages 3 or 4 (more advanced endometriosis) involve severe adhesions and endometriomas, which can have a major impact
- Stages 1 or 2 (milder cases) may only involve small implants of endometriosis, which can still affect fertility but to a lesser degree
The stage, severity, and location of lesions and implants all play a significant role in how endometriosis affects fertility.
The good new isany women with endometriosis go on to have successful pregnancies, especially with the right fertility treatment and medical support.
How can you tell if you have endometriosis?
One of the biggest challenges with endometriosis is that it is often undiagnosed for years because its symptoms can mimic other conditions like IBS, pelvic inflammatory disease (PID), and fibroids.
The most common symptoms of endometriosis include:
- Pelvic pain
- Moderate to severe menstrual cramps
- Pain during sexual intercourse
- Heavy or irregular menstrual bleeding
- Painful bowel movements or urination (especially during menstruation)
- Fatigue, bloating, nausea, or gastrointestinal discomfort
Some women with endometriosis have no symptoms at all. A pelvic exam can sometimes reveal signs of endometriosis, such as hard nodules at the bottom of the pelvis.
Ultrasound is another useful tool for identifying endometriosis. Endometriosis growing very deep inside the ovaries can form a cyst called an endometrioma, and these cysts can be seen on ultrasound. However, most smaller implants of endometriosis cannot be seen on ultrasound. Ultrasound can only detect advanced stage 3 or 4 endometriosis, while smaller implants and adhesions seen in Stage 1 or 2 may not be visible.
If you’ve been trying to conceive for 6–12 months without success and experience any of these symptoms, it may be time to consult a fertility specialist.
How is endometriosis diagnosed?
Symptoms and signs of endometriosis and even ultrasounds can make a provider suspicious of endometriosis, but the only way to definitively diagnose the condition is through laparoscopy. A laparoscopy is a minimally invasive procedure that allows a surgeon to look inside the pelvis using a laparoscope, which is a thin, telescopic rod with a video camera on the end. Not only can laparoscopic surgery confirm endometriosis, but the procedure can treat it as well.
A comprehensive fertility evaluation can also help determine the best path forward and may include hormone testing to assess ovarian reserve alongside a pelvic ultrasound and, in some cases, a hysterosalpingogram (HSG) to check for fallopian tube blockages.
Why does surgical expertise matter? Because advanced endometriosis (Stage 3 or 4) often involves severe adhesions affecting the ovaries, intestines, bladder, and ureter, it is highly recommended that the laparoscopy be performed by a skilled reproductive surgeon rather than a general gynecologist.
- A skilled reproductive surgeon can both diagnose and remove endometriosis in one procedure. (You don’t want to undergo surgery just for diagnosis, only to need a second procedure for treatment)
- A less experienced surgeon may leave some endometriosis behind or be unable to treat complex adhesions.
At CCRM Fertility, we have skilled reproductive surgeons experienced in treating advanced endometriosis, ensuring patients receive the highest level of care for both diagnosis and treatment.
New advances in endometriosis testing
In the last seven years, innovative diagnostic measures have been developed to help determine if a woman with no symptoms or ultrasound evidence might have endometriosis. It also helps physicians decide who would be a good candidate to undergo laparoscopy.
Back in the 1980s and 1990s, it was standard procedure that everyone with infertility undergo laparoscopy, but now we try to be much more selective. The ReceptivaDX test, an endometrial biopsy performed in the office, checks or samples the uterine lining and measures a protein called BCL6, a marker usually associated with endometrial inflammation and potentially silent endometriosis.
An abnormal biopsy result usually means there is endometriosis or inflammation in the pelvis. This biopsy can be very helpful for women who have no symptoms, evidence of endometriosis on ultrasound, or unexplained infertility.
Fertility treatment options for endometriosis
While endometriosis can make conception more challenging, there are several effective fertility treatments available. At CCRM Fertility, we take a personalized approach to treatment based on your age, severity of symptoms, ovarian reserve, and family-building goals. Treatment options include:
Intrauterine Insemination (IUI)
- Recommended for mild endometriosis
- Involves placing sperm directly into the uterus ahead of ovulation to improve fertilization chances
In Vitro Fertilization (IVF)
- Best for moderate to severe endometriosis
- Helps bypass common fertility challenges like tubal blockages and inflammation
- Improves the chances of successful embryo implantation
Egg Freezing for Future Fertility
- Since endometriosis can affect ovarian reserve, egg freezing allows patients to preserve fertility for the future
For some patients, surgical intervention may also improve fertility outcomes, including laparoscopic excision surgery — a highly effective method to remove endometriosis lesions while preserving ovarian function — and other fertility-sparing procedures designed to enhance pregnancy chances post-surgery.
When to see a fertility specialist for endometriosis
If you think you might have endometriosis, it is imperative to seek out an experienced reproductive surgeon specialized in treating advanced endometriosis. Their expertise ensures that you receive the highest level of care for both diagnosis and treatment, improving your chances of achieving a successful pregnancy.
If you have endometriosis and are trying to conceive, seeking care from a fertility expert sooner rather than later can significantly improve your chances of success. This journey can be frustrating and emotionally exhausting, but you don’t have to navigate it alone. With the right care, support, and treatment, pregnancy is possible.
Request a consultation with CCRM Fertility to explore your fertility options and develop a personalized treatment plan.
