Q1: What is endometriosis?
Endometriosis is a common condition that affects approximately 10–15% of women of reproductive age. It happens when tissue similar to the lining of the womb (uterus) grows in other areas of the body, such as the ovaries, fallopian tubes, or pelvis. It is unclear why this happens but it could be due to retrograde menstruation and sometimes there is a family history of the condition.
Endometriosis stages what it means to you
| Stage I (Minimum) | Small spots of endometriosis on the surface of organs. Very mild scarring |
| Stage II (Mild to Moderate) | More spots of endometriosis that go a little deeper. Slightly more scarring than Stage I. |
| Stage III (Moderate) | Deeper endometriosis growths, small cysts on the ovaries, and noticeable scarring around pelvic organs. |
| Stage IV (Severe) | Deep endometriosis growths, large cysts on the ovaries, and significant scarring that can affect how organs move. |
https://www.inovifertility.com/blog/stage-4-endometriosis/
Q2: Does endometriosis always cause pain and is there a link with infertility?
Endometriosis does not always cause pain or fertility problems. Many people with the condition have no symptoms and many with endometriosis can conceive naturally. There is however a link between endometriosis and difficulty conceiving, although the exact reason is not fully understood. 30-50%of women who struggle to get pregnant are found to have endometriosis.
Q3: How can endometriosis affect fertility?
The reasons endometriosis can cause fertility problems are not fully known, but may include:
• Inflammation that affects sperm transport
• Scarring or adhesions that block the tubes or distort pelvic anatomy.
• Endometriotic ovarian cysts (“chocolate cysts”) that may reduce egg quality or the number of available eggs.
• Disrupted ovulation due to inflammation around the ovaries.
• Possible effects on the lining of the womb that make implantation more difficult
Q4: What can I take for the pain while trying to get pregnant?
Painkillers such as ibuprofen, paracetamol, or codeine can help control endometriosis pain. However, you should avoid NSAIDs (like ibuprofen) and reduce or stop codeine once you start trying for a baby, as these can affect your pregnancy if you conceive.
Q5: Can acupuncture help with endometriosis pain?
Yes. Some research shows that acupuncture can reduce period pain and improve overall wellbeing and quality of life for women with endometriosis.
Q6: Can I use hormonal treatments if I’m trying to get pregnant?
No. Hormonal treatments (like the pill, progesterone injections, or GnRH drugs) are helpful for pain relief but are not suitable when trying to conceive as they temporarily stop ovulation — meaning you can’t get pregnant while using them.
Q7: How likely am I to get pregnant depending on how severe my endometriosis is?
| Group of Women | Chance of Pregnancy After 1 Year of Trying |
| No endometriosis | 84% |
| Minimal–Mild | 75% |
| Moderate | 50% |
| Severe | 25% |
Q8: What things do doctors consider when choosing treatment for infertility caused by endometriosis?
Your treatment plan will be tailored to you. Doctors will consider:
- How long you’ve been trying to conceive
- Your age and your partner’s age
- How often you have intercourse
- Any hormonal problems
- Your lifestyle and stress levels
- Previous treatments you’ve had
- Whether you experience pelvic pain or other symptoms
Question 9: Should an endometrioma (chocolate cyst) be removed prior to fertility treatment?
Surgical removal could damage the ovary and deplete your egg count. Therefore it is recommended to proceed with fertility treatment unless the ovarian cyst is painful or there are concerning features or your eggs cannot be collected and access is needed.
Question 10: Do I need surgery before IVF for my endometriosis? Can it improve my fertility?
Surgery may be required if you have severe symptoms, if the cyst is growing quickly, or if the ultrasound shows any concerning features.
For mild to moderate endometriosis, removing or destroying the endometriosis (using laser or heat) can slightly increase the chance of getting pregnant.
For severe endometriosis, it’s less clear whether surgery helps. Surgery can also reduce ovarian reserve, so doctors weigh the risks and benefits carefully
Question11: When is surgery not recommended before IVF?
Surgery may not be recommended for various reasons, for example if you have had previous surgery or your egg count is low.
Question12: What is the role of ovulation induction for infertility in women with endometriosis according to ESHRE?
Ovulation induction can help some women with mild endometriosis by encouraging the ovaries to release eggs. When this is combined with intrauterine insemination (fertility treatment where a doctor places prepared sperm directly into the womb at the time of ovulation to help the sperm reach the egg more easily) the chance of getting pregnant is higher than waiting naturally or doing IUI without medication. It works best in the first six months after surgery for endometriosis. Stronger fertility medicines called gonadotrophins are usually used. Tablets like clomiphene or letrozole also helps, although they have not been well studied in women with endometriosis. For women with more severe endometriosis, ovulation induction does not seem to work as well, so doctors usually recommend other treatments like IVF.
Q13: How successful is IVF if I have endometriosis?
IVF (in vitro fertilisation) can still be effective, but success rates are a slightly lower than in women without endometriosis. The more severe the disease, the lower the success rates.
Doctors sometimes give a short course of GnRH agonist injections before IVF to temporarily switch off the ovaries — this can improve IVF success.
Q14: Can endometriosis come back after treatment?
Yes. Endometriosis can return, even after medication or surgery. The risk depends on how severe it was, what treatment you had, and whether you became pregnant afterwards.
Q15: Does pregnancy make endometriosis go away?
Pregnancy often improves symptoms temporarily, because hormone levels during pregnancy stop the normal menstrual cycle. However, symptoms may return after childbirth or once your periods start again.
Q16: What can I do myself to help my fertility and wellbeing?
- Eat a healthy, balanced diet and maintain a healthy weight
- Avoid smoking and reduce alcohol
- Manage stress and seek emotional support
- Exercise regularly
- Get early referral to a fertility specialist
Q17: How long should I wait to try for a baby after laparoscopic surgery for endometriosis?
The best time to try is usually within one year of your laparoscopy, before endometriosis has a chance to return. If your endometriosis was mild, you may wait up to two years — your doctor will guide you on what’s best.
Q18: What are my chances of conceiving after successful surgery?
Your doctor can calculate your chances using the Endometriosis Fertility Index (EFI). A higher EFI score means a better chance of natural conception. This score considers:
- How long you’ve been infertile
- The extent and location of your endometriosis
- Your age
- Whether you’ve been pregnant before
Q19: What fertility treatments might I be offered if I still can’t conceive?
Aside from IVF, IUI and ovulation induction, you may wish to consider alternative therapy (such as accupuncture), adoption, surrogacy or fostering.
Q20: Does endometriosis affect pregnancy and what risks should I be aware of?
Endometriosis does not always cause problems in pregnancy. However miscarriages and ecopic pregnancies are more common. There is also an increased risk high blood pressure and diabetes. We would recommend you speak to your Obstetrician in pregnancy.
Q21: Can endometriosis affect my mental wellbeing?
Endometriosis can be emotionally and physically draining — especially when it causes pain, repeated surgeries, or fertility struggles. It’s common to feel anxious, frustrated, or low. If you’re struggling, speak to your doctor or a counsellor. Support groups and mental health professionals can make a big difference.
Recommended sites
RCOG, Information for you, endometriosis:
Endometriosis.uk, Endometriosis, Fertility and Pregnancy:
http://www.endometriosis-uk.org/sites/default/files/files/Information/fertility.pdf
ESHRE, Information for women with endometriosis:
https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline/Patient-version.aspx