Endometriosis and fertility: tests, treatment options and next steps

Endometriosis can affect fertility in different ways, but having the condition does not necessarily mean you will have difficulty getting pregnant. Understanding your individual reproductive health can help you make informed decisions about trying to conceive and whether treatment may be useful.

At London Women’s Clinic, we consider endometriosis alongside factors such as your age, ovarian reserve, fallopian tubes, previous surgery and wider fertility history. If you have endometriosis or suspect you may have it and are planning a pregnancy, book a fertility health assessment to better understand your fertility and next steps.

In this guide, we explore the tests that may be recommended and the treatment options available, from trying naturally to IUI and IVF.

Can endometriosis affect fertility?

Endometriosis can affect fertility, although its impact varies considerably from person to person. Many people with endometriosis are able to conceive naturally without difficulty, while others may benefit from fertility treatment.

If severe, the condition can cause inflammation and scar tissue or adhesions within the pelvis, which may affect the ovaries or fallopian tubes. If the tubes become damaged or their movement is restricted, it can be more difficult for an egg and sperm to meet. Endometriosis can also cause ovarian cysts known as endometriomas, which may need to be considered during IVF treatment.

There may also be effects on egg quality or the environment needed for fertilisation and implantation, although fertility is influenced by many factors and endometriosis should not automatically be assumed to be the cause of difficulties conceiving. Your age, ovarian reserve, tubal health, sperm quality and previous treatment history can all contribute to the overall picture.

When should you seek fertility advice if you have endometriosis?

You do not necessarily need to wait until you have been trying to conceive for a set period of time before seeking fertility advice. An earlier assessment may be worthwhile if you have diagnosed or suspected endometriosis, particularly if you also have an endometrioma, significant symptoms or a history of surgery involving the ovaries.

Age is another important consideration. If you are 35 or over, speaking to a fertility specialist sooner can help you understand your ovarian reserve and other factors that may influence your options. Advice may also be useful if you have been trying to conceive without success, have experienced repeated unsuccessful fertility treatment cycles, or are concerned about how previous endometriosis treatment could affect your fertility.

A fertility assessment can look beyond endometriosis itself, considering your reproductive history, ovarian reserve, fallopian tubes and, where relevant, semen results. This can help determine whether continuing to try naturally, further investigation or fertility treatment should be discussed.

If you experience new, severe or rapidly worsening symptoms, seek medical advice from your GP, gynaecologist or an urgent care service.

What fertility tests matter with endometriosis?

Fertility testing with endometriosis is about building a complete picture of the factors that could affect your chances of conceiving and using the results to guide what happens next. Your age, symptoms, previous surgery, how long you have been trying to conceive and any previous fertility treatment will help determine which checks are appropriate.

A fertility health assessment can provide a useful starting point. Depending on your history, endometriosis fertility tests may include ovarian reserve testing, pelvic imaging, assessment of the fallopian tubes and semen analysis where relevant.

Ovarian reserve testing

Ovarian reserve testing helps estimate the number of eggs remaining in the ovaries and can provide useful information when planning fertility treatment. An AMH blood test can be considered alongside an antral follicle count (AFC), which uses an ultrasound to count the small follicles within the ovaries.

Assessing ovarian reserve can be particularly important if you have ovarian endometriomas or have previously had surgery involving an ovary. Both the condition and previous treatment can be relevant when considering ovarian reserve, so these results should be interpreted alongside your age and medical history rather than in isolation.

Ultrasound, MRI and laparoscopy

A pelvic ultrasound can help identify ovarian endometriomas and assess the ovaries and other pelvic structures. If deeper endometriosis is suspected, a specialist ultrasound or an MRI scan may sometimes be used to understand the location and extent of the disease.

Normal imaging does not completely rule out endometriosis. Where symptoms and clinical history still suggest the condition, a specialist may discuss whether laparoscopy – keyhole surgery that allows the pelvis to be examined directly – is appropriate. The aim of fertility investigations is not necessarily to pursue a surgical diagnosis in every case, but to gather the information needed to make informed decisions about fertility and treatment.

Tubal checks and pelvic factors

Endometriosis can sometimes cause adhesions or changes to the anatomy of the pelvis that affect the fallopian tubes. Checking whether the tubes are open may therefore form part of your assessment, particularly if you are considering trying naturally or having IUI.

Tubal health can also influence which treatment route is appropriate. For example, significant tubal damage or pelvic adhesions may make IUI less suitable, while IVF can bypass the fallopian tubes. Your results will be considered alongside other fertility factors before a treatment plan is recommended.

Semen analysis and wider fertility checks

Endometriosis may be one part of the fertility picture rather than the only factor involved. Other causes of female infertility, as well as sperm-related factors, can also influence your chances of conceiving. Where sperm from a male partner is being used, semen analysis can assess sperm count, movement and shape, identifying whether sperm-related factors also need to be considered.

Your specialist can bring these results together with your ovarian reserve, tubal health, age and endometriosis history. If sperm factors or previous problems with fertilisation are identified, this may also influence whether treatments such as ICSI are considered.

If you have endometriosis and are unsure which fertility tests you need, book a fertility health assessment to review your fertility history, ovarian reserve and other factors with one of our specialists.

Which treatment options may be considered?

There is no single endometriosis fertility treatment that is right for everyone. The most suitable approach will depend on factors including your age, ovarian reserve, fallopian tube health, semen results, the location and extent of endometriosis, previous surgery and how long you have been trying to conceive.

For some people, continuing to try naturally may be reasonable after assessment. Others may benefit from surgery or fertility treatment such as IUI or IVF. The aim is to choose a route based on all the factors affecting your fertility rather than treating endometriosis in isolation.

Trying naturally after assessment

If your fertility tests are reassuring, your fallopian tubes are open and endometriosis appears to be mild, you may be advised to continue trying naturally for a period of time by timing intercourse around ovulation.

How long you try naturally for will depend on your individual circumstances. Age, ovarian reserve, symptoms and the length of time you have already been trying are among the factors that can influence this decision.

Surgery before fertility treatment

Surgery might be an option when endometriosis is affecting fertility, particularly where there are significant symptoms, endometriomas or changes to the pelvic anatomy. In some circumstances, treating endometriosis surgically may improve the chance of conceiving naturally.

However, surgery is not routinely required before IVF and needs particularly careful consideration when ovarian endometriomas are involved. Surgery involving an ovary can affect ovarian reserve, so the potential benefits need to be weighed against its possible impact on the number of eggs available for future treatment. Your age, ovarian reserve, symptoms, previous surgery and the size and location of an endometrioma can all influence this decision.

Hormonal treatments can help manage endometriosis symptoms, but they are not used to improve fertility while you are actively trying to conceive. If pain or other symptoms require treatment alongside your fertility plans, your fertility specialist and gynaecologist can help coordinate the best approach.

IUI and endometriosis

IUI may be an option for some people with mild endometriosis, including those using donor sperm. It involves placing prepared sperm directly into the uterus around the time of ovulation, but fertilisation still needs to take place within the fallopian tube.

For that reason, IUI and endometriosis may not be a suitable combination if the fallopian tubes are damaged or blocked, significant pelvic adhesions are present or the disease is more extensive. Other fertility factors, including age, ovarian reserve and semen results, also need to be considered when deciding whether IUI is suitable for you.

IVF and ICSI for endometriosis-related infertility

IVF may be recommended where endometriosis is affecting the fallopian tubes, where pregnancy has not occurred with other approaches, or where age, ovarian reserve or other fertility factors make it appropriate to move to assisted conception.

With IVF, the ovaries are stimulated to produce eggs, which are collected and fertilised in the laboratory before an embryo is transferred to the uterus. Because fertilisation takes place outside the body, IVF can bypass problems involving damaged or blocked fallopian tubes.

Endometriosis IVF treatment does not automatically require ICSI. ICSI involves injecting a single sperm directly into an egg and may be recommended where there are sperm-related factors or previous concerns about fertilisation.

Frozen embryo transfer and treatment planning

Depending on your treatment plan, an embryo may be transferred during the IVF cycle in which the eggs are collected, or suitable embryos may be frozen for transfer at a later stage. A frozen embryo transfer (FET) allows the embryo transfer to take place in a subsequent cycle. Whether a fresh or frozen transfer is recommended will depend on your treatment plan and how your IVF cycle progresses.

When an implantation review may be useful

Endometriosis can be one factor in a complex fertility history, but an unsuccessful embryo transfer does not necessarily mean that endometriosis has caused an implantation problem. If you have experienced repeated failed transfers or have a more complex history of fertility treatment, a specialist review may help identify whether there are factors worth exploring before another cycle.

Our Implantation Clinic provides specialist assessment for patients experiencing recurrent implantation failure or repeated unsuccessful treatment. Your previous IVF cycles, embryo development, transfer history and uterine environment can be considered together to determine whether additional investigations or changes to treatment may be relevant.

A practical next-step decision tree

The next step with endometriosis and fertility depends on your starting point. These are some of the pathways that may be discussed after assessment:

These are not fixed pathways. Your age, ovarian reserve, fallopian tubes, semen results where relevant, symptoms, previous surgery and treatment history all contribute to the decision about what to do next.

Questions to ask at your fertility consultation

A consultation is an opportunity to understand how endometriosis may relate to your fertility and what your results mean for your options going forward. Useful questions could include:

●      What do my AMH and antral follicle count tell us about my ovarian reserve?

●      Do I need my fallopian tubes assessed before deciding on treatment?

●      Is there any reason to consider surgery before trying to conceive or starting fertility treatment?

●      If I have an endometrioma, how could surgery affect my ovarian reserve?

●      Could IUI be suitable for me, or would IVF be a better option?

●      If IVF is recommended, would endometriosis affect how you plan my stimulation protocol?

●      Are there any reasons to consider a fresh or frozen embryo transfer?

●      If I have had previous unsuccessful transfers, would an implantation review be useful?

●      How can my endometriosis symptoms be managed alongside my fertility plans?

Book an endometriosis fertility review with LWC

Endometriosis can affect fertility differently from one person to another, which is why understanding your individual circumstances is an important first step. At London Women’s Clinic, our fertility specialists can assess factors including your ovarian reserve, pelvic and tubal health, previous surgery and wider fertility history before discussing the options that may be suitable for you.

If you are at the beginning of this process, book a fertility health assessment to explore your fertility and discuss your results with a specialist. If you already have test results or a history of fertility treatment, you can contact London Women’s Clinic to arrange a consultation and discuss your next steps.

Fertility treatment can also take an emotional toll, particularly if you have experienced pain, surgery or previous unsuccessful cycles. Our counselling and support services are available alongside fertility care if you would like additional support during your treatment.

FAQs

Can you get pregnant if I have endometriosis?

Yes. Many people with endometriosis can become pregnant naturally, although the condition can make conceiving more difficult for some. Your individual chances and treatment options depend on factors including your age, ovarian reserve, fallopian tube health, extent of the endometriosis, semen results where relevant and previous fertility history.

What fertility tests should I have if I have endometriosis?

There is no single set of endometriosis fertility tests that everyone needs. A specialist may recommend a pelvic ultrasound, AMH testing and an antral follicle count, alongside semen analysis where relevant. Tubal assessment, specialist imaging or other investigations may also be recommended depending on your symptoms and medical history.

Is IVF better than surgery for endometriosis?

Neither option is universally better. Surgery may be beneficial in some circumstances, while IVF may be recommended where factors such as age, ovarian reserve, tubal damage, previous surgery or other fertility issues make assisted conception more suitable. Surgery involving an endometrioma also needs careful consideration because it can affect ovarian reserve.

Can removing an endometrioma affect fertility?

Yes, potentially. Surgery to treat an endometrioma may be beneficial in some circumstances, but it can also affect ovarian reserve. Your specialist can weigh these considerations alongside your fertility plans before recommending whether surgery is the right next step.

Does hormonal treatment improve fertility if I am trying to conceive?

Hormonal treatments can help reduce pain associated with endometriosis, but they are not used to improve fertility while you are actively trying to conceive. NICE advises that hormonal treatment should not be offered to improve spontaneous pregnancy rates in people with endometriosis who are trying to conceive.

Is IUI suitable if I have endometriosis?

IUI may be considered in selected cases of mild endometriosis or when using donor sperm. It is generally less suitable where there is tubal damage, significant pelvic adhesions, more severe disease or other fertility factors that make IVF a more suitable option.

Does endometriosis cause failed implantation?

Endometriosis may be one factor affecting implantation, but it should not automatically be assumed to be the cause of an unsuccessful embryo transfer. If you have experienced repeated failed transfers, our Implantation Clinic can review your embryo, transfer and treatment history to consider whether further assessment may be useful.

When should I book a fertility review?

It may be worth seeking fertility advice if you have confirmed or suspected endometriosis and are trying to conceive, particularly if you have an endometrioma, previous endometriosis surgery, significant symptoms or have been trying without success. A review can also be useful if you are considering IVF and want to understand how endometriosis and your wider fertility health may influence your treatment options.