Trying to conceive when you have endometriosis can bring up an important question: should you try for pregnancy naturally, treat the endometriosis first, or consider fertility treatment?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
There is no single approach that works for everyone. Endometriosis can affect fertility in different ways, and the right treatment depends on factors such as your age, ovarian reserve, severity and location of endometriosis, duration of infertility, previous surgery, fallopian tube function and your partner's fertility factors.
When pregnancy is the priority, treatment is approached differently from treatment aimed mainly at controlling pain. You can learn more about the condition and its broader treatment options on the Endometriosis Treatment page.
How Can Endometriosis Affect the Chances of Pregnancy?
Endometriosis does not mean that natural pregnancy is impossible. Many women with endometriosis conceive without fertility treatment. However, the condition can reduce fertility in some people.
Endometriosis may affect fertility through inflammation, pelvic adhesions, changes in the anatomy around the ovaries and fallopian tubes, ovarian endometriomas, or other changes within the reproductive environment.
The extent of the disease does not always correspond directly to fertility. Someone with relatively limited endometriosis may experience difficulty conceiving, while another person with more extensive disease may become pregnant naturally.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Should You Do If You Have Endometriosis and Want to Get Pregnant?
The first step is usually a fertility-focused assessment rather than automatically starting endometriosis treatment. Your healthcare team may consider:
- Your age
- How long you have been trying to conceive
- The location and extent of endometriosis
- Whether an ovarian endometrioma is present
- Ovarian reserve
- Whether you are ovulating regularly
- The condition of the fallopian tubes
- Previous endometriosis surgery
- Previous pregnancies or fertility treatments
- Semen analysis and other fertility factors involving the partner
These factors help determine whether trying naturally, surgery, intrauterine insemination (IUI), in vitro fertilisation (IVF), or another approach may be appropriate.
Can You Try to Conceive Naturally With Endometriosis?
Yes. If there are no major factors preventing natural conception, trying to conceive without immediate fertility treatment may be reasonable for some women.
However, the amount of time spent trying naturally should not be decided by endometriosis alone. Age, ovarian reserve, the duration of infertility and other fertility factors are important when deciding whether it is appropriate to continue trying or move to treatment.
For someone with a lower expected chance of spontaneous pregnancy, prolonged expectant management may delay treatment unnecessarily.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Does Hormonal Treatment Help You Get Pregnant?
Hormonal treatments are commonly used to control endometriosis-associated pain, but they are not used to improve the chance of spontaneous pregnancy.
Hormonal contraception and other hormone-suppressing treatments generally prevent pregnancy while they are being used. Current evidence does not show that hormonal suppression improves fertility in women with endometriosis.
If you are actively trying to conceive, your treatment plan therefore needs to be different from one designed primarily for symptom control.
Hormonal treatment may still have a role if you decide not to try for pregnancy immediately or need a period of symptom management before pursuing fertility treatment.
What If You Have Deep Endometriosis?
Deep endometriosis can involve structures such as the bowel, bladder, ureters or tissues surrounding the reproductive organs.
Surgery may be appropriate for some women with deep endometriosis, particularly when symptoms require treatment. However, there is not compelling evidence that surgery for deep endometriosis consistently improves fertility.
When pregnancy is the priority, the potential benefits of surgery need to be balanced against surgical risks, possible effects on ovarian reserve and the time that may be lost before attempting pregnancy.
What If You Have an Ovarian Endometrioma?
An ovarian endometrioma is a cyst associated with endometriosis that develops within an ovary. Its presence does not automatically mean that surgery is required before trying to conceive.
Surgery may sometimes increase the chance of natural pregnancy in selected cases, but removing an endometrioma can also damage ovarian tissue and reduce ovarian reserve.
For this reason, the decision to operate should consider the woman's age, ovarian reserve, symptoms, cyst characteristics, previous surgery and fertility plans rather than relying on the presence of an endometrioma alone.
When Might IUI Be Considered?
Intrauterine insemination (IUI) places prepared sperm directly into the uterus around the time of ovulation. In selected women with minimal or mild endometriosis, IUI combined with ovarian stimulation may be considered.
IUI may be less suitable when there are significant anatomical problems, blocked fallopian tubes, severe endometriosis or other factors that substantially reduce the likelihood of success.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The evidence for IUI specifically in endometriosis is more limited than for some other fertility conditions, so the decision should be individualised.
When Might IVF Be Considered?
In vitro fertilisation may be considered when the likelihood of natural conception is reduced or when other approaches have not resulted in pregnancy.
IVF may be discussed particularly when:
- There are additional infertility factors.
- The fallopian tubes are blocked or significantly affected.
- Ovarian reserve is a concern and delaying treatment may not be appropriate.
- Previous fertility treatment has not resulted in pregnancy.
- Endometriosis is moderate or severe and natural conception is less likely.
- Age makes prolonged attempts at natural conception less desirable.
- The estimated chance of natural pregnancy after surgery is low.
IVF can bypass some problems involving the fallopian tubes and allows fertilisation to take place outside the body. It does not, however, cure endometriosis.
What Happens to Fertility After Endometriosis Surgery?
After surgery, some women may choose to try to conceive naturally. Others may proceed to medically assisted reproduction.
The decision can depend on the expected chance of spontaneous pregnancy, age, ovarian reserve, previous fertility history and other fertility factors.
If natural conception is attempted after surgery, the length of time before moving to fertility treatment should also be considered carefully, particularly when age or ovarian reserve makes time important.
What If Endometriosis Treatment and Fertility Treatment Conflict?
This is one of the reasons fertility planning should happen early. A treatment that is useful for controlling endometriosis symptoms may not be appropriate while actively trying to conceive.
Similarly, an operation that treats an endometrioma may have potential consequences for ovarian reserve. The goal is therefore not simply to treat the endometriosis as extensively as possible. It is to choose an approach that balances symptom control with the person's reproductive goals.
Endometriosis Fertility Treatment: What Factors Matter?
| Factor | Why It Matters |
|---|---|
| Age | Age influences fertility and may affect how long it is reasonable to try naturally. |
| Ovarian reserve | Helps assess reproductive potential and is particularly important when ovarian surgery is being considered. |
| Endometriosis location and extent | May affect pelvic anatomy, ovarian function and the likelihood of natural conception. |
| Ovarian endometrioma | May influence fertility planning, while surgery can potentially affect ovarian reserve. |
| Fallopian tubes | Blocked or damaged tubes can make natural conception more difficult and may influence the choice of assisted reproduction. |
| Partner's fertility | Sperm quality can contribute to infertility and should be assessed when appropriate. |
| Previous surgery | Previous operations can affect pelvic anatomy and ovarian reserve. |
| Pain symptoms | Significant symptoms may influence whether surgery should be considered even when fertility is the primary goal. |
| Duration of infertility | Helps determine whether continued attempts at natural conception are appropriate. |
Can Endometriosis Treatment Improve Natural Fertility?
In selected cases, surgical removal of endometriosis may improve the chance of spontaneous pregnancy. However, this does not mean that more extensive surgery always leads to better fertility outcomes.
The potential benefit of surgery should be weighed against possible complications and, particularly with ovarian surgery, the possibility of reducing ovarian reserve.
Medical treatments that suppress ovarian function are useful for symptom control but do not improve the chance of spontaneous pregnancy while being used.
A Practical Approach When You Want to Conceive
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
If you have endometriosis and pregnancy is your goal, the process may look different from treatment aimed mainly at controlling symptoms:
- Assess fertility factors: Review age, ovarian reserve, ovulation, tubes, endometriosis characteristics and partner fertility.
- Discuss your reproductive timeline: Consider how long you have been trying and whether delaying treatment could affect your chances.
- Decide whether surgery is appropriate: Consider symptoms, anatomy, ovarian reserve, previous surgery and expected fertility benefit.
- Estimate the chance of natural pregnancy: When appropriate, tools such as the Endometriosis Fertility Index may help with decision-making after surgery.
- Consider assisted reproduction when appropriate: IUI or IVF may be options depending on the fertility assessment.
- Continue endometriosis care: Fertility treatment and long-term management of endometriosis may need to be addressed separately.
The Bottom Line
When pregnancy is the goal, endometriosis treatment needs to be planned around fertility rather than treating symptoms in isolation. Some women may be able to try for pregnancy naturally, while others may benefit from surgery, IUI or IVF.
Surgery can improve the chance of spontaneous pregnancy in selected cases, but it is not automatically necessary before trying to conceive or before IVF. This is particularly important when an ovarian endometrioma is present because ovarian surgery can affect ovarian reserve.
The most appropriate approach depends on the complete fertility picture—including age, ovarian reserve, endometriosis characteristics, previous surgery, fallopian tube function, partner fertility and how long you have been trying to conceive.
A personalised fertility assessment can help determine whether continuing to try naturally or moving toward fertility treatment is appropriate.
