Endometriosis and Infertility: Symptoms, Diagnosis & Treatment

Written by: Parivar Saathi Editorial Team

Editorial review: Dr. Deeksha Goswami, Senior Fertility Counsellor

Published: June 17, 2026

Quick Answer

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside it, most often on the ovaries, fallopian tubes, and the lining of the pelvis. It can cause painful periods, pelvic pain, pain during intercourse, and difficulty conceiving. Around 30 to 50% of women with endometriosis experience infertility, because it can distort pelvic anatomy, cause inflammation, and affect egg quality and implantation. The good news: many women with endometriosis still conceive, especially with early diagnosis and the right treatment plan, which may include laparoscopic surgery, ovulation support, IUI, or IVF. If you have painful periods and have been trying to conceive for 6 to 12 months, it is worth getting evaluated.

Key Facts at a Glance

• Endometriosis affects roughly 1 in 10 women of reproductive age, about 190 million women worldwide (WHO).

• Around 30 to 50% of women with endometriosis have trouble conceiving, and it is found in up to 25 to 50% of women evaluated for infertility.

• Common symptoms: painful periods, chronic pelvic pain, pain during intercourse, heavy bleeding, and difficulty conceiving, though some women have none.

• Diagnosis is based on history, pelvic examination, ultrasound, and sometimes MRI; laparoscopy is the most definitive test but is not always required.

• Severity is graded by the ASRM system from Stage I (minimal) to Stage IV (severe), though stage does not always match pain or fertility difficulty.

• Treatment for fertility includes laparoscopic surgery, ovulation induction with IUI, or IVF, chosen to fit each person.

• Hormonal medicines such as birth control pills help with pain but do not improve fertility, so they are paused while trying to conceive.

What Is Endometriosis?

The endometrium is the tissue that lines the inside of the uterus and sheds each month as your period. In endometriosis, tissue that behaves much like this lining grows in places it should not, commonly on the ovaries, the outer surface of the uterus, the fallopian tubes, and the lining of the pelvis. This misplaced tissue still responds to your monthly hormones, so it builds up and bleeds with each cycle. But because the blood has nowhere to drain, it causes inflammation, scar tissue (adhesions), and sometimes cysts on the ovaries called endometriomas, or chocolate cysts.

Endometriosis is a long-term, often under-recognised condition. Many women live with symptoms for years before getting a clear answer, partly because painful periods are so often dismissed as normal. Understanding what is happening in your body is the first step toward getting help that actually works.

What Are the Symptoms of Endometriosis?

Symptoms vary a great deal from person to person, and their severity does not always reflect how extensive the condition is. Some women with mild endometriosis have severe pain, while others with advanced disease have none and only discover it during a fertility evaluation. The most common signs include:

• Painful periods (dysmenorrhoea): cramping more intense than usual that may begin before your period and last several days.

• Chronic pelvic pain: a dull or sharp ache in the lower abdomen or back that can occur outside of your period.

• Pain during or after intercourse (dyspareunia), often felt deep in the pelvis.

• Heavy menstrual bleeding or bleeding between periods.

• Pain with bowel movements or urination, especially during your period.

• Difficulty conceiving, which is sometimes the first and only sign.

• Fatigue, bloating, or nausea, particularly around menstruation.

If period pain regularly disrupts your work, sleep, or daily life, that is not something you simply have to endure. It is a reason to speak with a doctor.

How Does Endometriosis Affect Fertility?

Endometriosis can reduce fertility through several overlapping mechanisms, which is why its impact differs so much between women:

• Distorted anatomy and adhesions: scar tissue can bind the ovaries, tubes, and uterus together, making it harder for an egg to be picked up and travel down the tube.

• Inflammation: chronic inflammation in the pelvis can affect egg quality, sperm function, and the natural interaction between egg and sperm.

• Reduced ovarian reserve: endometriomas on the ovary, and surgery to remove them, can lower the number of healthy eggs available.

• Impaired implantation: changes in the uterine environment may make it harder for an embryo to implant.

It is important to hold two truths at once: endometriosis is a real and common cause of infertility, and a great many women with endometriosis go on to conceive, naturally or with treatment. A diagnosis is not a verdict; it is information that helps you and your care team choose the right path.

How Is Endometriosis Diagnosed?

There is no single blood test for endometriosis. Diagnosis usually combines several steps:

• Symptom history: your doctor will ask about period pain, pelvic pain, pain during sex, and how long you have been trying to conceive.

• Pelvic examination: sometimes nodules or tenderness can be felt, though a normal exam does not rule endometriosis out.

• Transvaginal ultrasound: useful for detecting ovarian endometriomas and deeper disease.

• MRI: may be used to map deeper or more complex disease before surgery.

• Laparoscopy: keyhole surgery that lets the surgeon see and treat endometriosis directly. It is the most definitive test, but current guidelines support starting treatment based on symptoms and imaging without always requiring surgery first.

If you are being evaluated for difficulty conceiving, endometriosis assessment usually sits alongside other checks such as ovulation, ovarian reserve, tubal patency, and your partner's semen analysis. Looking at the whole picture, both partners, gives the clearest plan.

What Are the Treatment Options for Endometriosis and Fertility?

Treatment depends on your symptoms, your age, the stage of endometriosis, your ovarian reserve, how long you have been trying, and whether there are other fertility factors. Broadly, the options are:

Laparoscopic surgery. Removing or destroying endometriosis tissue and freeing adhesions can relieve pain and, in earlier-stage disease, improve the chance of natural conception. Surgery on ovarian endometriomas is done carefully, because removing cyst tissue can also reduce egg reserve, so the decision is individualised.

Ovulation induction with IUI. For milder disease with open fallopian tubes and a healthy sperm count, stimulating ovulation combined with intrauterine insemination can be a reasonable next step.

IVF (in vitro fertilisation). IVF is often the most effective option for moderate-to-severe endometriosis, when the tubes are affected, when ovarian reserve is reduced, when there is a male factor, or when other treatments have not worked. Because IVF bypasses the tubes and the pelvic environment, it can work well even when anatomy is distorted.

What about hormonal medicines? Birth control pills and other hormonal therapies are very useful for managing endometriosis pain, but they work by suppressing ovulation, so they are paused when you are actively trying to conceive. This is an important distinction many women are not told clearly.

When Should You See a Fertility Specialist?

Because endometriosis can quietly affect fertility and may progress over time, it is wise not to wait too long. Consider getting evaluated if you have painful periods or known endometriosis and you have been trying to conceive for 6 months if you are over 35, or 12 months if you are under 35, or sooner if your symptoms are severe. Early evaluation does not commit you to any treatment; it simply gives you time and options. A diagnosis like this carries emotion as well as medical questions, and you do not have to navigate it alone; speaking with a fertility counsellor can help you make calm, informed choices.

Frequently Asked Questions

Can I get pregnant naturally with endometriosis?

Yes. Many women with mild to moderate endometriosis conceive naturally, especially when the fallopian tubes are open and ovulation is normal. Endometriosis lowers the monthly chance of conception rather than removing it. If you have been trying for 6 to 12 months without success, an evaluation can identify what extra support, if any, would help.

Does endometriosis always cause infertility?

No. Around 30 to 50% of women with endometriosis experience fertility difficulties, which means many do not. The condition affects women very differently, and the visible severity does not reliably predict fertility. Some women with advanced endometriosis conceive easily, while others with mild disease struggle. A personalised assessment matters far more than the diagnosis alone.

Will treating endometriosis improve my chances of conceiving?

It can. Laparoscopic surgery may improve natural conception in earlier-stage disease, and IVF is highly effective for moderate-to-severe cases or when tubes are affected. The best approach depends on your age, ovarian reserve, and other factors. Hormonal medicines ease pain but do not improve fertility, so they are paused while trying to conceive.

Is endometriosis pain related to how serious it is?

Not necessarily. Pain severity does not reliably match the amount of endometriosis present. Some women with extensive disease feel little pain, while others with minimal disease have severe symptoms. This is why diagnosis relies on a combination of history, examination, imaging, and sometimes laparoscopy rather than pain levels alone.

Can endometriosis come back after surgery?

Yes, endometriosis can recur after surgery, since it is a chronic condition. This is one reason many specialists encourage trying to conceive without long delay after surgical treatment, when fertility is the goal. Your doctor will help you plan timing, and may recommend IVF rather than repeat surgery in certain situations.

Should my partner be tested too?

Yes. Fertility is a shared picture, and a male factor is present in roughly a third to a half of couples having difficulty conceiving. A simple semen analysis for your partner, done alongside your own evaluation, gives the most complete view and helps avoid missing a treatable factor in either of you.

Key Takeaways

• Endometriosis is a common condition where uterus-like tissue grows outside the uterus, affecting about 1 in 10 women of reproductive age.

• It can cause painful periods, pelvic pain, pain during intercourse, heavy bleeding, and difficulty conceiving, but some women have no symptoms.

• It affects fertility through adhesions, inflammation, reduced ovarian reserve, and impaired implantation, yet many women still conceive.

• Diagnosis combines symptom history, pelvic exam, ultrasound, MRI, and sometimes laparoscopy.

• Treatment options for fertility include laparoscopic surgery, ovulation induction with IUI, and IVF, chosen individually.

• Early evaluation gives you more options. If you have painful periods and are trying to conceive, speak to a specialist.

Related Reading

Blocked Fallopian Tubes: Symptoms, Causes & Treatment

AMH Test: What Your Result Means About Fertility

Semen Analysis Test: What It Checks and How to Read Your Report

PCOS and Fertility: A Complete Guide to Conception and Treatment

When Should You Consider IVF?

Fertility Counselling at OPDs: Why It Matters

Medical References

• World Health Organization (WHO): Endometriosis Fact Sheet.

• National Institute for Health and Care Excellence (NICE): Endometriosis - diagnosis and management (NG73).

• American College of Obstetricians and Gynecologists (ACOG): Endometriosis.

• American Society for Reproductive Medicine (ASRM): Endometriosis and Infertility, a committee opinion.

• Mayo Clinic: Endometriosis - Symptoms, Causes, Diagnosis and Treatment.

• European Society of Human Reproduction and Embryology (ESHRE): Guideline on the management of endometriosis.

About the Author and Reviewer

Written by the Parivar Saathi Editorial Team, a group of health writers dedicated to making fertility information clear, accurate, and compassionate for couples across India.

Editorial review by Dr. Deeksha Goswami, Senior Fertility Counsellor at Parivar Saathi, who guides couples through diagnosis, treatment choices, and the emotional side of the fertility journey.

Disclaimer

This article is for general information and education only and is not a substitute for professional medical advice, diagnosis, or treatment. Endometriosis and fertility care must be individualised. Always consult a qualified doctor or fertility specialist about your specific situation.