Endometriosis and Fertility

If you have endometriosis, questions about fertility can arrive long before you are ready to answer them. Will it affect my chances? Should I try now? Would surgery help or harm? What about IVF? It is normal to feel uncertainty, fear, frustration, hope and pressure all at once.

This page is for anyone thinking about pregnancy now, planning for the future, or simply wanting to understand how endometriosis and its treatment might affect them later on. Every situation is different, and nothing here replaces a conversation with your own clinician. But knowing the basics helps you ask better questions and make decisions with more confidence.

Does endometriosis always affect fertility?

No. Having endometriosis does not mean you will definitely have difficulty getting pregnant. Many people with endometriosis conceive without any fertility treatment at all.

That said, endometriosis is associated with fertility challenges for some:

• Around 30% of people with endometriosis experience infertility
• Up to 50% of people with infertility are found to have endometriosis

Fertility is influenced by many things at once: age, egg supply and quality, sperm factors, fallopian tube function, ovulation, the uterus, previous surgery, other health conditions, and how long you have been trying. Endometriosis is one factor among these, and the right advice depends on your age, symptoms, goals and individual situation.

The key message: endometriosis can affect fertility, but it does not make pregnancy impossible.

How can endometriosis affect fertility?

The effect depends on the type, location and severity of disease.

In milder endometriosis, the pelvic environment becomes inflamed. This can interfere with how eggs, sperm and embryos function, including the egg reaching the tube, sperm function, fertilisation, and the embryo’s journey down the tube.

In moderate or severe endometriosis, the effect is often more mechanical. Adhesions can distort the pelvic anatomy, and the fallopian tubes may become blocked or unable to pick up the egg.

Endometriomas (sometimes called chocolate cysts) can affect the ovaries directly, reducing egg supply or interfering with ovulation. Surgery on the ovary can also reduce egg supply, which is why an ovary-sparing approach matters so much.

Painful sex can make trying to conceive harder simply through avoidance, which is a real and often overlooked factor.

None of this means pregnancy is impossible. It does mean it is worth getting the right assessment, advice and support.

When should I seek fertility advice?

For people without known fertility concerns, the usual advice is to seek help after 12 months of trying.

If you know you have endometriosis or adenomyosis, it is reasonable to seek advice earlier, after around six months of trying. If you are also over 35, consider bringing that forward to around four months.

You may want to seek early advice if:

• You have known or suspected endometriosis or adenomyosis
• You are over 35
• You have one ovary or one fallopian tube
• You have been told your AMH is low
• You have had previous unsuccessful fertility treatment
• You have painful sex that makes regular intercourse difficult
• You are unsure whether to keep trying naturally, consider surgery, or explore fertility treatment

There is no harm in seeking advice from a fertility specialist early, even if you are not actively trying. Asking questions helps you understand your options and make decisions that are right for you.

What happens in a fertility assessment?

A good fertility assessment looks at the whole picture rather than endometriosis alone:

• Age
• Menstrual cycle and ovulation
• Fertility goals
• Previous medical and surgical history
• Ultrasound findings
• Known or suspected endometriosis
• Egg reserve testing such as AMH
• Fallopian tube function
• Sperm testing

Sperm should always be tested, even when endometriosis is already known. A person can have endometriosis and still find that it is not the main cause of their fertility delay.

AMH is not a complete measure of fertility. A low AMH may suggest a shorter reproductive window, but it does not measure egg quality or the chance of becoming pregnant. Age, sperm quality and many other factors matter just as much.

A fertility specialist can help you navigate the information and understand all the options available to you. Do not be afraid to ask for a second opinion. It does not mean you lack confidence in your clinician. A fresh perspective can reassure you that your options have been fully considered.

What are my options?

Your options depend on your age, symptoms, how long you have been trying, your test results, sperm testing, and how endometriosis is affecting your ovaries, tubes and pelvic anatomy. Possible options include:

• Trying naturally: appropriate for a period of time where age, ovulation, sperm results and other factors are encouraging, and endometriosis symptoms are manageable.
• Surgery: excision of endometriosis plays an important role, particularly for pain and visible disease, and restoring normal anatomy can improve the chance of conceiving naturally. When fertility is a goal, surgery needs careful thought, especially repeat surgery, which can further reduce ovarian reserve. Surgery is not recommended solely to improve IVF success.
• IUI (intrauterine insemination): may be discussed after a full fertility workup, depending on your circumstances.
• IVF (in vitro fertilisation): findings such as blocked tubes, significant adhesions, reduced egg supply, age or previous treatment history may make IVF a sensible next step.
• Egg freezing: worth considering if you are not ready to conceive but are concerned about your age, egg supply or future fertility. It may also be an option before surgery for more severe endometriosis. It is not accessible or affordable for everyone.
• Embryo banking: if you are starting a family later in life, or expect fertility delay, freezing embryos can give the best chance of a second or final child.

As a surgeon, my role is often to help you weigh surgery against these other pathways honestly. Sometimes the right answer is an operation. Sometimes it is a referral to a fertility clinic first, with surgery held in reserve. We make that call together, based on your goals rather than a default.

Pain, sex and trying to conceive

For some people with endometriosis, sex is painful. Over time the body begins to anticipate pain, which leads to anxiety, muscle tension and avoidance. Trying to conceive can add another layer, particularly when intercourse becomes timed, goal-focused or emotionally loaded. This can affect both partners and the relationship, and can bring grief, frustration, guilt or disconnection. These responses are understandable and are not a personal failure.

Things that help:

• Talk openly with your partner or a trusted support person about the pain, fear and expectations
• Work with a psychologist or sex therapist
• Reduce pressure around timed intercourse where possible
• Reframe intimacy as connection and closeness rather than performance
• See a pelvic physiotherapist

The emotional side

Fertility concerns can be emotionally demanding, especially alongside endometriosis. Hope, uncertainty, grief, frustration and anxiety often arrive together, and for some people these feelings start long before they begin trying. Many people grieve when endometriosis changes the timeline they had imagined for starting a family.

When things feel overwhelming, it can help to focus on what is within your control:

• What you know: seek information from trusted sources so you feel informed in your decisions
• What you can influence: specialist advice, your wellbeing, and choices that fit your values
• Where you can get support: your GP, a psychologist, a fertility specialist, a sex therapist, your partner, whānau, trusted friends, or organisations such as Endometriosis New Zealand

Self-compassion matters too. You are dealing with something genuinely hard. Respond to yourself with the same kindness you would offer a friend, rather than self-blame.

Fertility decisions are often made in the context of whānau, culture, faith and personal values. For Māori and Pasifika people, fertility uncertainty may also be shaped by cultural expectations or assumptions about parenthood. You are welcome to bring support people to appointments, and to ask for care that respects your cultural needs.

When fertility takes up too much space

Tracking symptoms, timing ovulation, waiting for results and managing disappointment can take a toll. Pregnancy announcements from friends or whānau can feel isolating. Online advice about fertility diets, supplements and “miracle” solutions adds pressure. Healthy habits support wellbeing, but fertility outcomes depend on many factors, and it is important not to blame yourself if pregnancy does not happen despite doing everything right.

It is okay to take a purposeful pause. Stepping back to rest, reconnect, gather information or look after your mental health is not giving up. Keep hold of the parts of your life that are not about fertility: work, friendships, creativity, recreation, spirituality, culture, or simply time to yourself.

Questions to ask

Ask as many questions as you need. Some to bring to your GP, gynaecologist or fertility specialist:

• How might my endometriosis affect my fertility?
• Based on my age and history, how long should I try naturally before seeking further help?
• What fertility investigations should I consider?
• Would surgery be likely to help my fertility, and how do I balance that with reducing my pain?
• Could hormonal treatment affect my future fertility?
• Could fertility treatment affect my endometriosis symptoms? What are the costs and eligibility?
• Is IUI appropriate for me? When should IVF be considered?
• Should I consider egg freezing? What is the process and cost?
• Who can I talk to if I feel overwhelmed or need to pause?
• If I become pregnant, how might endometriosis affect my pregnancy or care?
• If treatment is unsuccessful, or I decide not to continue, what other pathways to parenthood could I consider?

Thinking about fertility and endometriosis?

Whether you are trying now, planning ahead, or weighing up surgery, I can help you understand your options and work alongside fertility specialists to build a plan around your goals.

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FAQs

Helpful resources

• Endometriosis New Zealand – Fertility and endometriosis: Aotearoa’s national endometriosis organisation. Their “Endometriosis and Fertility” booklet, developed with a fertility specialist and a fertility counsellor, informed much of this page.
• Fertility New Zealand: Support, information and advocacy for people facing fertility challenges.
• Jean Hailes – Endometriosis: Australian women’s health resource with clear patient explanations.
• Healthify NZ – Endometriosis: Consumer-focused medical advice.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.