How does endometriosis affect fertility?
- It creates an inflammatory environment that can impair egg, sperm and embryo function.
- Adhesions can distort the tubes and their movement.
- Endometriomas and surgery for them can reduce ovarian reserve.
- Painful sex can make regular intercourse difficult.
Factors guiding treatment
- Age and ovarian reserve (AMH, antral follicle count)
- Severity of pain
- Presence and size of endometriomas
- Tubal patency
- Partner's semen analysis
- Duration of trying
When is surgery preferred?
For younger women with significant pain and good reserve, laparoscopic surgery can reduce pain and improve natural fertility; treating mild to moderate endometriosis laparoscopically has been shown to increase natural pregnancy rates. Surgery should preserve ovarian tissue as far as possible.
When is IVF preferred?
With older age, low reserve, tubal damage, male factor or no pregnancy after previous surgery, IVF is usually more appropriate. Routine removal of endometriomas before IVF is not recommended because it does not improve pregnancy rates and may reduce reserve; large cysts blocking egg collection or suspicious appearance are assessed separately.
If pregnancy must be delayed
Young women with endometriosis who must delay pregnancy, especially before ovarian surgery, should discuss egg freezing.
An individual approach
There is no single right path. Having gynaecological surgery and IVF assessed together by the same physician makes it easier to choose the right order.
Frequently Asked Questions
Does everyone with endometriosis become infertile?
Should an endometrioma be removed before IVF?
Sources
- ESHRE Guideline: Endometriosis, 2022.
- Practice Committee of the ASRM. Endometriosis and infertility: a committee opinion. Fertil Steril, 2012.
The information on this website is for general information only and does not replace a medical consultation.
