Endometriosis and Fertility: What It Means for Getting Pregnant

Receiving an endometriosis diagnosis can make questions about fertility feel suddenly urgent. However, it doesn’t automatically signal infertility. Many people with the condition become pregnant naturally, while others may need extra support through fertility treatment or surgery. Importantly, pregnancy isn’t impossible if you have endometriosis.

Fertility is personal, and your diagnosis is just one part of a bigger picture; it’s not a verdict on what happens next. We’ll explain how endometriosis can affect your fertility, what the research says about your chances of conceiving, and when it might be time to ask for help. 

Does Endometriosis Cause Infertility?

It’s true that endometriosis can make becoming pregnant more difficult, but it doesn’t always cause infertility. If you have mild to moderate endometriosis, your chance of having a baby naturally is similar to the wider population. More severe endometriosis can make it harder, but it doesn’t have to be. 

According to Endometriosis UK, the chance of getting pregnant depending on the severity of your condition is as follows:*

Yet, 60 to 70% of people with endometriosis get pregnant spontaneously, and it is possible even when the condition is severe*, so severity alone is not a reliable predictor of your fertility. Since March 2026, NICE guidance no longer uses “mild” or “severe” staging to guide fertility decisions.⁺ Instead, your care is based on your individual profile: how long you've been trying to conceive, your age, your ovarian reserve and any other fertility factors.

*Endometriosis UK. (2026). Endometriosis, Fertility and Pregnancy.

⁺NICE. (2026). New dedicated fertility treatment pathway for endometriosis.

How Endometriosis Can Affect Fertility

The exact reasons why endometriosis can affect fertility are not fully understood, mainly because of a lack of research. However, it’s thought that endometriosis can impact several of the steps required for successful conception, from the release of an egg from the ovaries (ovulation) to implantation in the womb. Even without any obvious structural abnormalities, factors such as inflammation and even your age may be affecting your chances of getting pregnant.  

Inflammation

Endometriosis is linked with inflammatory and immune changes in the fluid surrounding the pelvic organs. Researchers are investigating whether this environment affects sperm movement, fertilisation, implantation or embryo development.* However, inflammation does not make pregnancy impossible, but it may offer one explanation why some people have difficulties conceiving when their pelvic anatomy looks relatively normal. 

*Mohammed Rasheed HA, et al. (2020). Inflammation to Infertility: Panoramic View on Endometriosis.

Endometriomas

Endometriomas are cysts caused by endometriosis that develop on an ovary. They can damage nearby tissue and reduce your ovarian reserve, or the remaining supply of eggs in your ovaries.

Scar tissue and adhesions

Inflammation isn’t the only thing endometriosis can cause; it can also lead to scarring. Specific bands of scar tissue called adhesions can make pelvic organs stick together. For example, adhesions may pull an ovary or fallopian tube out of its usual position, making it harder for a fallopian tube to collect an egg after ovulation. If the tube becomes blocked, sperm may be unable to reach an egg, making fertilisation challenging.

Changes to pelvic anatomy

Endometriosis can change the relationship between the ovaries, fallopian tubes and uterus. In more extensive cases, the ovaries may become fixed behind the uterus, or adhesions may affect the bowel, bladder and reproductive organs.

These changes may interfere with egg release or transport. IVF can bypass some of these structural barriers because fertilisation takes place in a laboratory before an embryo is transferred into the uterus.

Age

Age is the biggest factor when it comes to fertility for everyone. You are born with a limited supply of eggs, which mature each month once you reach puberty, but the number and quality of these eggs decline in your 30s, particularly after age 37.* This matters especially if you have endometriosis, since you may not realise you have it until you have fertility issues.   

*Carlson K, et al. (2026). Age-Related Fertility Decline.

Can You Get Pregnant Naturally With Endometriosis?

Yes.  Many people who have endometriosis get pregnant naturally, with around 60 to 70% of people conceiving spontaneously.* Even after surgery for endometriosis, natural pregnancy is possible, with one study showing that 73% of women who attempted to get pregnant after surgery successfully conceived.⁺ 

*Endometriosis UK. (2026). Endometriosis, Fertility and Pregnancy.

⁺Nesbitt-Hawes EM, et al. (2015). The Surgical Treatment of Severe Endometriosis Positively Affects the Chance of Natural or Assisted Pregnancy Postoperatively. 

Does Pregnancy Cure Endometriosis?

No. Pregnancy does not cure endometriosis. Some people may notice less pain when they are pregnant because of the changes in hormone levels taking place or because their periods stop temporarily, but others can experience unchanged or even worsening symptoms. You may also experience temporary relief in symptoms if you are breastfeeding and your periods are absent. 

Unfortunately, endometriosis lesions and adhesions do not simply disappear, and you may notice your symptoms return when your menstrual cycles restart after birth. You may see pregnancy being described as a treatment for endometriosis, perhaps on social media or other websites, but this can be particularly unhelpful because it isn’t a cure and endometriosis can make conception already more challenging. Pregnancy is a personal choice and is not a guaranteed cure for endometriosis.

When to Seek Help Conceiving

If you are having trouble getting pregnant, it can feel like a lonely place to be, but there is help and support available. You should contact your GP for advice if you are:

• aged 35 and under and have been trying to conceive for one year

• aged 36 and over – there's no need to wait*

However, if you have been diagnosed with endometriosis, there is no need to wait until you have been trying to get pregnant for a certain amount of time before seeking help. Your clinician should consider your age, symptoms, ovarian reserve, how long you have been trying, previous treatment and any sperm-related fertility factors to provide a more personalised approach to fertility.  

*NICE. (2026). New dedicated fertility treatment pathway for endometriosis.

Fertility Treatment Options

If fertility is an issue for you, then treatment options are available, but there is no single treatment that will suit everyone with endometriosis. The right treatment depends on your age, priorities, symptoms, and the severity of your condition.

Expectant management

Expectant management is the fancy term for continuing to try naturally for a baby while being monitored. It may be most suitable where the likelihood of spontaneously becoming pregnant is high, and there is no reason to rapidly progress to fertility treatment.

Endometriosis surgery

Laparoscopic surgery to remove visible endometriosis, release adhesions or treat an endometrioma can improve the chance of pregnancy in some people. However, there are certain trade-offs. For example, operating on an ovary could reduce your ovarian reserve, or repeated surgery may contribute to the further loss of healthy tissue. 

Before surgery, speak to your clinician about how the procedure could affect:

• Your chance of natural conception

• Ovarian reserve

• Access to the ovaries during egg collection

• Pain and other symptoms

• The timing of fertility treatment

• The risks of leaving an endometrioma untreated

Intrauterine insemination (IUI)

During IUI, prepared sperm is placed directly inside your uterus around the time of ovulation to increase the chances of pregnancy. You may be given medication to stimulate your ovaries to release an egg. 

IUI still relies on an egg entering an open fallopian tube, so it may not be appropriate if both tubes are blocked or pelvic anatomy is substantially altered. Under the updated NICE pathway, up to 4 IUI cycles may be discussed for some people with endometriosis before moving to IVF.*

*NICE. (2026). NICE recommends new dedicated fertility treatment pathway for endometriosis.

IVF

IVF is an effective fertility treatment for people with endometriosis. It involves stimulating the ovaries, collecting eggs and fertilising them with sperm in a laboratory setting. One embryo is then transferred into your uterus. Since IVF bypasses the fallopian tubes, it can be especially useful when adhesions, tubal damage or altered anatomy are affecting your ability to get pregnant. 

IVF may be discussed sooner if:

• Both fallopian tubes are blocked

• Ovarian reserve is low

• Age makes further delay unhelpful

• There is a significant sperm-related factor

• Other treatment has not worked

• Surgery is unlikely to improve fertility

• Endometriosis significantly affects pelvic anatomy

What is the IVF success rate with endometriosis?

Studies into the outcomes of IVF in endometriosis report mixed results and can depend on your age, ovarian reserve, sperm quality, previous treatment and the number of available embryos. Some research shows that advanced endometriosis is linked with lower IVF success*, while a 2024 study found no significant difference in live birth rates between people with endometriosis and control groups.⁺

*Somigliana E, et al. (2023). Endometriosis and IVF treatment outcomes: unpacking the process.

⁺Mappa I, et al. (2024). The Effect of Endometriosis on In Vitro Fertilization Outcomes: A Systematic Review and Meta-Analysis.

Is IVF right for me?

Whether IVF is right for you will depend on several factors, including the organs affected by your endometriosis and how long you have been trying to conceive. Because endometriosis can create an inflamed pelvic environment and, in many cases, block the fallopian tubes, IVF works by bypassing these physical barriers completely because fertilisation occurs in a laboratory. 

Start by having a conversation with your clinician about the fertility options available to you. For some people, having sex at the right time in their cycle is enough to help them get pregnant naturally, even with endometriosis, but others may need some extra support.

FAQs

Can you get pregnant with stage 4 endometriosis?

Yes. Pregnancy can occur naturally or with fertility treatments even in severe cases of endometriosis. The stage of your condition cannot reliably predict fertility outcomes, which is also why NICE no longer uses “mild” and “severe” labels to direct fertility decisions. Instead, your clinician will consider your age, ovarian reserve, fertility goals and how long you have been trying for a baby to find the right fertility options for you. 

Does endometriosis get better after pregnancy?

Not always. For some people, symptoms may temporarily improve because pregnancy stops their periods and changes hormone levels, but it can depend on the individual. For example, some people find that their symptoms get worse. Pregnancy does not remove endometriosis lesions or adhesions, and symptoms can return once your menstrual cycles restart after birth.

Is IVF necessary for endometriosis?

No. Research shows that 60 to 70% of people with endometriosis conceive spontaneously, either naturally or following surgery.* IVF may be recommended when the fallopian tubes are blocked, ovarian reserve is reduced, another fertility factor is present or less invasive approaches have not worked. Your age and how long you have been trying also matter.

*Endometriosis UK. (2026). Endometriosis, Fertility and Pregnancy.

Does endometriosis affect egg quality?

Possibly. Some research suggests that severe endometriosis can affect egg quality, but the evidence is inconsistent.* Age is one of the strongest influences on egg quality. For example, older age is associated with poorer egg quality, especially after age 35.⁺ *Esmaeilzadeh S, et al. (2022). Stages of endometriosis: Does it affect oocyte quality, embryo development and fertilization rate?

⁺Carlson K, et al. (2026). Age-Related Fertility Decline.

What are the risks of endometriosis during pregnancy?

Most pregnancies progress normally, but endometriosis is associated with higher rates of miscarriage, ectopic pregnancy, placenta praevia, premature birth and caesarean delivery.* These are relative increases in risk, not predictions about your pregnancy. 

*Tsikouras P, et al. (2024). The Impact of Endometriosis on Pregnancy.

What does early pregnancy feel like with endometriosis?

Early pregnancy symptoms are usually the same whether or not you have endometriosis, including a missed period, breast tenderness, tiredness and nausea. You may also experience mild cramps or no symptoms at all. Pregnancy symptoms alone cannot tell you whether a pregnancy is developing healthily. Contact your GP or local midwife service if you think you are pregnant for advice on what you should do next.