Blog post written in collaboration with UR Vistahermosa
How does endometriosis affect fertility?
Endometriosis can compromise fertility in up to 30–50% of affected patients. Diagnosed patients with endometriosis have roughly one-third of the monthly fecundity rate of the general population, ranging between 2 -10% per month. The condition disrupts fertility at multiple stages, affecting ovarian function, oocyte quality, endometrial receptivity, tubal patency, and overall pelvic anatomy.
In this article, UR Vistahermosa shares the treatment options available for women with endometriosis and the important considerations when undergoing them.
Natural conception with monitoring
For younger women with no other significant fertility issues, timed intercourse combined with ovulation induction can be an option. Medications like Letrozole may be prescribed to stimulate ovulation, and regular monitoring via ultrasound and hormone testing helps time intercourse for the best chance of conception.
Intrauterine Insemination (IUI)
IUI is often recommended when endometriosis is present, but the fallopian tubes remain open. Sperm is directly inserted into the uterus to improve fertilization chances, with success rates of approximately 10 15% per cycle. If IUI is not successful by about 3 cycles, in vitro fertilization should be considered.
In Vitro Fertilization (IVF)
IVF is considered the most effective assisted reproductive technology for endometriosis. This treatment requires a woman to take small injections of fertility medications which cause many eggs to grow in the ovaries. These are monitored with blood and ultrasound tests, then retrieved under light anaesthesia via a needle guided by ultrasound through the vaginal wall. The eggs are placed with sperm in a laboratory, and resulting embryos are transferred into the uterus a few days later.
Surgery (Laparoscopy)
In general, when women are younger than 35, it is reasonable to remove any visible endometriosis to see if pregnancy occurs naturally. If women are 35 or older, other fertility treatments are recommended instead of laparoscopy.
However, surgery carries its own risks. Surgical therapy can increase the chances of natural conception, but at the same time, it increases the risk of damage to ovarian reserve, which is why each case must be individualised.
Egg/Oocyte Freezing (Fertility Preservation)
Women with endometriosis, particularly those with bilateral ovarian endometriomas or recurrent surgery on the ovaries, should be advised about the risk of ovarian reserve damage. Oocyte cryopreservation is an established technique demonstrated as feasible and successful for these patients. This is especially relevant for women who aren’t ready to conceive now but want to protect future options.
Stopping hormonal treatment:
Most women with endometriosis who wish to conceive need to stop their hormonal treatment; therefore, their symptoms may return and the disease may progress. Specialists recommend completing detailed imaging (MRI or transvaginal ultrasound) before discontinuing medication.
Disease stage matters:
Several well-controlled studies have shown that neither medical nor surgical treatment for mild endometriosis improves pregnancy rates compared to expectant management. For severe endometriosis, the infertility is usually resistant to ovarian stimulation plus IUI.
The bottom line is that treatment should be personalized based on age, disease severity, ovarian reserve, and reproductive goals. A multidisciplinary team, gynecologist, reproductive endocrinologist, and possibly a surgeon specializing in endometriosis, gives the best outcomes. It’s worth consulting a specialist early, as ovarian reserve can decline over time.
Learn more about UR Vistahermosa here.
Enhanced Fertility Programme was founded by Andreia Trigo RN BSc MSc, Fertility Nurse Consultant, giving you access to personalised fertility diagnostics and care.
