Endometriosis can cause scar tissue and adhesions to form in and around your reproductive organs. This can make it more difficult for you to get pregnant. Many people with endometriosis get pregnant without medical assistance, but some will need treatment or intervention to help them conceive.

There are several different treatments to help with endometriosis-related infertility. Scar tissue and adhesions can be removed during a minimally invasive surgical procedure. Medications can help make ovulation and implantation more successful. And assisted reproductive technologies can be used to bypass affected organs.

Endometriosis is a condition that happens when endometrial-like tissue grows outside your uterus, where it doesn’t belong.

Endometrial tissue is what lines the inside walls of your uterus. When it grows outside the uterus, this tissue behaves the same way it does inside the uterus. It can respond to hormonal changes, which means it can grow and bleed at different times during your menstrual cycle.

This process causes inflammation in the area around the endometrial growths, which can be very painful. It can also lead to a buildup of scar tissue and adhesions. Adhesions are a tough, sticky type of tissue that can bind your organs together.

Endometriosis affects more than 10 percent of people with a uterus between ages 15 and 44.

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Endometriosis causes mild to severe pain, especially around the time of your period. It might feel like really bad period cramps, or it might feel more like chronic pain in the pelvic area. But some people have no symptoms at all.

Many people have no idea they have endometriosis until they have difficulty getting pregnant.

Endometriosis can range from mild to severe. Generally, the more severe your condition is, the harder it can be to get pregnant. But even mild endometriosis can adversely affect fertility.

Although it may sound odd, the severity of your endometriosis pain is not related to the overall severity of your condition.

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Endometriosis may affect fertility in several ways.


Endometriosis can cause scar tissue, cysts, and adhesions to form in and around your reproductive organs. This tissue can interfere with the conception process.

When a mature egg is released from one of your ovaries, it’s supposed to travel through a fallopian tube and into your uterus. Scar tissue and ovarian cysts can make this journey impossible by:

  • preventing the release of an egg
  • preventing the fallopian tubes from picking up an egg
  • blocking the fallopian tubes

Adhesions can also cause your ovaries to stick to your uterus, making it harder for the fallopian tube and ovary to connect. Scar tissue and lesions may also alter the shape of your uterine cavity. This may make it harder for an embryo (fertilized egg) to implant itself in your uterus.

Egg quality

Endometriosis causes inflammation in and around the reproductive organs. This inflammatory environment may be less hospitable to conception. It can impact egg quality and maturation. It can also impact the fertilization and implantation process.

Inflammation also affects hormone production by reducing the ovaries’ ability to produce ample amounts of estrogen and progesterone.

Scar tissue in and around the ovaries can also alter blood flow, reducing the ovaries’ oxygen supply and diminishing egg quality and maturation.

Pain during sex

Endometriosis can cause severe pain during and after penetrative vaginal sex. This can make it difficult to have sex during your fertile window. The pressures of baby-making sex can be challenging at best for couples trying to conceive. When you add physical pain to the equation, it can be even tougher.

It’s estimated that 30 to 50 percent of people who receive an endometriosis diagnosis experience infertility.

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Infertility is generally defined as trying to get pregnant for more than 1 year without success.

There are many issues that can interfere with fertility, and they affect people of all genders. To help find the cause of your infertility, your doctor may advise several tests. These may include:

  • physical exam, including a gynecological exam
  • blood tests to check your hormone levels and ovarian reserve (egg supply)
  • imaging tests, such as a sonogram to view your uterus and reproductive organs
  • hysterosalpingogram to check for blockages in the uterus and fallopian tubes

If you’ve been having difficulty getting pregnant, your doctor may suspect endometriosis, even if you haven’t experienced any symptoms in the past. If endometriosis is suspected, your doctor may recommend a laparoscopy.

Diagnostic laparoscopy

Laparoscopy is the gold standard for diagnosing endometriosis. It allows your doctor to see what’s happening inside your body. This helps them confirm an endometriosis diagnosis and determine how much your condition has progressed.

Laparoscopy is a minimally invasive surgery typically done under general anesthesia. Your surgeon will make a small incision in your abdomen. A laparoscope, which is a slender instrument with a camera and light at its tip, will be inserted into the incision. Through this camera, your surgeon can look for patches of endometriosis and identify any scar tissue or adhesions that might be interfering with fertility.

Laparoscopy is also used to remove endometrial growths (also called implants) and scar tissue. The surgical removal of blockages can help make it easier to conceive, especially for those with moderate to severe endometriosis.

Endometriosis is a progressive disorder, which means it can get worse over time. Your doctor may categorize your condition by stage. Stages are determined by the extent of endometriosis and how far it has spread.

Endometriosis stages don’t predict infertility and are not related to the amount of pain you experience.

The stages of endometriosis

  • Stage 1 (minimal). There are a few superficial endometrial implants and minimal scar tissue.
  • Stage 2 (mild). This stage has more implants that go deeper into the body, as well as some scar tissue.
  • Stage 3 (moderate). There are many deep implants, filmy adhesions, and small cysts on one or both ovaries.
  • Stage 4 (severe). This stage involves many deep implants, thick adhesions, and large ovarian cysts.
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Endometriosis is also categorized by type. The types include:

  • Superficial peritoneal lesions. This is the most common type. These endometrial growths occur in the peritoneum, a thin film that lines the inside of your abdomen. The lesions are thin and flat.
  • Endometriomas. Endometriomas are ovarian cysts that contain endometriosis patches and old blood. Due to their color, endometriomas are sometimes called chocolate cysts.
  • Deeply infiltrating endometriosis (DIE). Endometrial implants are classified as deeply infiltrating if they grow deep into your tissues and reproductive organs. They can also affect nearby organs like the bladder or bowels.

What is the Endometriosis Fertility Index?

The Endometriosis Fertility Index (EFI) is a scoring system that doctors occasionally use to help them make treatment decisions. This system helps predict the likelihood of conception without medical assistance after laparoscopic surgery.

In addition to endometriosis staging information, the EFI takes other factors into account. These include:

  • maternal age
  • time spent trying to conceive
  • history of prior pregnancy

If you have or suspect you have endometriosis and you’re having trouble getting pregnant, a fertility specialist may be able to help.

Your doctor may recommend you try intrauterine insemination (IUI) or in vitro fertilization (IVF), which are both assistive reproductive technologies. In some cases, your doctor may recommend surgery to treat endometriosis.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a simple and cost-effective fertility treatment. During this procedure, sperm is inserted directly into the uterus. This quick procedure is done in a doctor’s office and requires no recovery time.

Many people doing an IUI procedure take fertility medications in the weeks before the procedure. Medications like clomiphene citrate (Clomid) help stimulate the ovaries so they will produce more eggs.

These medications do raise your estrogen levels, which means your endometriosis pain may temporarily increase.

IUI and IVF can be performed using sperm from a partner, friend, or donor.

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If you are using a partner’s sperm, they will provide a sample via masturbation on the day of your procedure. The sperm will be “washed” and concentrated for insemination. If you use donor sperm, it will be thawed prior to treatment.

When you are ready and ovulating, the sperm will be inserted into your uterus through a thin, flexible tube. IUI is not usually painful.

In vitro fertilization (IVF)

IVF is a more advanced form of assisted reproductive technology. The process begins with hormonal medications that stimulate the ovaries to produce eggs. You are monitored throughout your cycle to see how your body responds to these medications. Using blood tests and ultrasounds, your doctor can monitor the growth of your eggs.

Once your follicles reach the right size, your eggs are retrieved or removed from the ovaries during an egg retrieval procedure. The procedure is performed under anesthesia.

After the eggs are removed, they are taken to a laboratory where they are mixed with sperm to create embryos. These embryos mature and develop in the lab. When they’re ready, they can either be transferred into the uterus or frozen and saved for a later date.

The embryo transfer process is similar to an IUI procedure. The embryo is placed directly into the uterus through the cervix using a thin, flexible tube.

Surgical treatment (laparoscopy)

Endometriosis is often treated during a laparoscopy. This minimally invasive procedure can be used to help:

  • diagnose endometriosis
  • determine its severity
  • treat endometriosis

The goal of the procedure is to remove as much of the endometriosis and scar tissue as possible. This can be achieved through:

Removing the endometriosis and treating any abnormal tissue can help improve fertility and decrease the painful symptoms of endometriosis. Surgery is not curative, but it can significantly improve symptoms.

Endometriosis can recur after surgery, so it’s important to speak with your doctor about strategies to manage the condition after surgery.

Treating endometriosis pain when you’re trying to conceive

When you aren’t trying to get pregnant, endometriosis symptoms are often treated with hormonal birth control methods. These treatments can’t be used when you are trying to conceive. This means you may be in more pain during this time.

Medications used to stimulate ovulation can also make endometriosis symptoms worse and make you feel bloated, increasing your discomfort.

Talk with a doctor about pain management strategies.

Acupuncture is often recommended for endometriosis pain management. It may also be beneficial for enhancing IVF success, according to a 2020 study.

Endometriosis can affect fertility in several ways. Scar tissue and adhesions can alter the anatomy of the pelvic area, causing blockages and other issues. Inflammation can impact egg quality and maturation. And the fertilization and implantation process can be affected.

There are several treatment options available for people with endometriosis who are experiencing difficulty becoming pregnant. Talk with a healthcare professional about your symptoms and fertility goals to determine the best course of action for you.