Endometriosis can affect fertility, but it doesn’t make pregnancy impossible. Many people with endometriosis can conceive, sometimes naturally, sometimes with medical support.
If you’re trying to conceive and have endometriosis—or suspect you might—it can be helpful to speak with a reproductive endocrinologist. They can assess your individual case and recommend next steps, whether that means tracking ovulation more closely, considering fertility treatments, or simply giving it more time.
However, understanding how endometriosis works is a valuable first step.
Endometriosis and Fertility
Endometriosis can make conception more complex, but it doesn’t rule it out. Many people with endometriosis are able to get pregnant with different types of support.
What Is Endometriosis?
Endometriosis is a chronic condition where tissue similar to the endometrium—the lining of the uterus—grows outside the uterus.
These endometrial-like cells can implant on the ovaries, fallopian tubes, bowel, and other pelvic structures. This tissue responds to the hormonal changes of the menstrual cycle, thickening and bleeding each month. But because it’s outside the uterus, it has no way to leave the body, which leads to inflammation, pain, and eventually, the formation of scar tissue (adhesions).
This inflammatory process can have systemic effects. Endometriosis is now recognized as more than a localized pelvic condition—it's associated with altered immune responses, changes in hormone signaling, and disruptions in ovarian function, all of which can affect fertility.
How Endometriosis Can Impact Fertility
Endometriosis can interfere with fertility in a few different ways.
- Distorted anatomy: Adhesions and ovarian endometriomas (sometimes called “chocolate cysts”) can physically block or damage the fallopian tubes, disrupt the release of eggs, or alter the position of reproductive organs.
- Inflammation: The pelvic environment in endometriosis tends to have high levels of pro-inflammatory cytokines and prostaglandins, which can impair sperm function, egg quality, and embryo implantation.
- Ovarian reserve: Some people with endometriosis, particularly those with endometriomas, may experience a decline in ovarian reserve (the number and quality of remaining eggs), sometimes reflected in lower AMH (Anti-Müllerian Hormone) levels.
- Endometrial receptivity: The condition may also affect how well the uterine lining supports implantation, even when embryos are healthy.
That said, endometriosis affects everyone differently. Some people conceive with no difficulty, while others may benefit from targeted fertility support.
Is Natural Conception Possible?
Yes, many people with endometriosis are able to conceive naturally. Natural conception may take some more time for some or require additional support, but for others, it can happen quickly.
What to Know About Natural Conception With Endometriosis
Endometriosis can affect fertility in several ways, but it doesn’t automatically mean you’ll need medical intervention to get pregnant. In fact, studies suggest that women with mild to moderate endometriosis may conceive without medical intervention.
That said, moderate to severe endometriosis may make it harder to get pregnant without assistance. This is often due to inflammation, scarring, or structural changes in the reproductive organs.
Factors That Can Affect Fertility
Everyone's body, history, and circumstances are different. Several factors can shape the likelihood of getting pregnant naturally when endometriosis is part of the picture:
- Age: Fertility naturally declines with age, and that curve can be steeper for those managing endometriosis.
- Severity of endometriosis: More widespread or deeply rooted endometriosis may make it harder to conceive without help.
- Other fertility factors: Ovulation issues, sperm health, and even unrelated conditions like thyroid disorders can also play a role.
How the Stages of Endometriosis May Play a Role
Doctors classify endometriosis in four stages—minimal, mild, moderate, and severe—based on how much tissue is present and where it’s located. It might look like this:
- Stage 1 (Minimal): Small spots of endometriosis with little to no scarring.
- Stage 2 (Mild): More tissue growth with light scarring.
- Stage 3 (Moderate): Deeper growths, possible cysts on the ovaries, and more noticeable scarring.
- Stage 4 (Severe): Extensive growths, large ovarian cysts, and significant scar tissue.
Generally, people with stage 1 or 2 are more likely to conceive naturally than those with stage 3 or 4. However, staging isn’t always predictive. Some people with advanced endometriosis conceive without intervention, while others with mild disease may struggle. Fertility is influenced by many interrelated factors—not just stage alone.
If you’re younger than 35 and have been trying to conceive for over 12 months (or over 6 months if you’re 35 or older) without success, A comprehensive evaluation can help you better understand your options and what next steps make the most sense for you.
Potential Challenges of Conceiving with Endometriosis
Endometriosis can introduce some specific challenges when it comes to conceiving. Broadening your understanding of how it may affect your fertility can help you prepare and make more informed decisions moving forward.
Endometriosis Can Damage or Block Reproductive Organs
One of the more visible ways endometriosis can interfere with fertility is through physical changes to the reproductive system.
Endometrial-like tissue may attach to the ovaries, fallopian tubes, or pelvic structures. Over time, this can result in scar tissue (adhesions), cysts (endometriomas), or altered organ positioning.
These changes may:
- Prevent the ovary from releasing an egg properly
- Block the fallopian tube, making it harder for sperm to reach the egg
- Disrupt the path of a fertilized egg on its way to the uterus
These physical barriers are a common reason for reduced fertility in people with moderate to severe endometriosis. Imaging, diagnostic surgery, or fertility testing can help clarify whether this is a factor in your case.
Hormonal and Immune Imbalances Can Disrupt Fertility
Endometriosis isn’t just a structural condition—it also impacts the body on a deeper, more invisible level. Hormonal imbalances can disrupt ovulation, while inflammation and immune system changes may make the uterus less receptive to pregnancy.
Additionally, some research suggests that endometriosis may cause the uterine environment to be less receptive to a fertilized egg, even when ovulation and fertilization occur normally.
These systemic effects often don’t show up on imaging or physical exams, which can make diagnosis and treatment less straightforward. This is one reason why working with a provider who understands endometriosis thoroughly can make a meaningful difference.
Endometriosis May Raise the Risk of Pregnancy Complications
For those who do become pregnant, endometriosis can still pose some risks. Research shows a higher likelihood of certain complications, such as:
- Early pregnancy loss
- Preterm birth
- Placenta previa (when the placenta covers the cervix)
- Preeclampsia (a blood pressure-related condition)
The exact risk varies depending on the severity and location of the disease. Most people with endometriosis who become pregnant go on to have healthy, full-term deliveries, but proactive monitoring during pregnancy is still recommended.
How to Support Your Chances of a Natural Pregnancy With Endometriosis
If you’re trying to conceive with endometriosis, you may have questions about what you can do to support your fertility. While there’s no single formula that works for everyone, there are some steps you can take that can help you care for your body and understand your cycle more clearly.
Everyday Habits to Support Your Reproductive Health
Lifestyle changes won’t treat endometriosis itself, but they can help create a healthier environment for conception. These approaches are simple, evidence-informed ways to care for your body:
- Choose nutrient-dense foods
A balanced, whole-food diet—rich in leafy greens, fruits, legumes, whole grains, and lean proteins—may support hormone balance and reduce inflammation. This isn’t about restriction, but about giving your body the nutrients it needs to function well. - Move regularly
Gentle, consistent exercise—such as walking, swimming, stretching, or low-impact strength work—can improve circulation and may help ease pain and inflammation. It can also help stabilize mood and support metabolic health. - Manage stress
Chronic stress can affect hormone regulation and make symptoms harder to manage. Strategies like deep breathing, therapy, mindfulness, or simply creating space for rest can help regulate the stress response. - Support your body’s natural rhythms
Basic habits like staying hydrated and getting enough sleep matter. These foundational choices support immune function, hormonal regulation, and energy levels. - Track your cycle
Monitoring your menstrual cycle can give you insight into your body’s ovulation patterns and help you identify timing that might improve your chances of conception. It also gives your care team more information to work with if further evaluation is needed.
Small changes may not feel significant at first, but they can build over time. If something helps you feel better—physically or mentally—it’s worth continuing. If it doesn’t, that’s useful information, too.
Understanding Ovulation and Timing With Confidence
Tracking your ovulation can increase your chances of conceiving naturally. While endometriosis may make cycles less predictable for some, it’s still very possible to identify your fertile window.
You might consider:
- Ovulation predictor kits (OPKs): These detect the surge in luteinizing hormone (LH) that occurs before ovulation.
- Basal body temperature (BBT): Tracking BBT can help confirm when ovulation has occurred.
- Cervical mucus monitoring: Changes in cervical mucus can signal fertile days.
If your cycle is irregular or these tools feel confusing, a provider can help interpret patterns and recommend some next steps.
When to Reach Out for Medical Support
If you’ve been trying to conceive for 12 months without success—or if you’re over 35 and have been trying for six months—it’s a good idea to speak with a fertility specialist.
As reproductive endocrinologist Dr. Amanda Adeleye explains, early evaluation and clear communication with a healthcare professional can help you understand what’s happening in your body and give you the opportunity to talk through your options.
You don’t need to wait to ask for help. Getting medical insight sooner rather than later can save you time and open up more options, whether that means continuing to try naturally, exploring medication, or considering assisted reproductive technologies.
Treatment Options if Natural Conception Is Challenging
The journey to pregnancy with endometriosis doesn’t always follow the path you may have imagined. Despite making lifestyle changes and trying to time things just right, conception may still seem out of reach. But here’s the good news: there are supportive, effective treatment options available that can help make pregnancy a reality.
Medical Treatments
When natural conception proves difficult, there are a number of medical treatments designed to either help treat endometriosis symptoms or even enhance fertility. Here’s a closer look at some of the most common approaches:
- Hormonal therapies: Medications like birth control pills, progestin-only options, and GnRH agonists can help reduce the growth of endometrial tissue and inflammation. For many, these treatments can offer relief from endometriosis pain, but can make conception more difficult.
- Pain management: Endometriosis can be incredibly painful. Over-the-counter pain relievers like ibuprofen or naproxen can help make the process more manageable and allow you to focus on other steps in your journey.
- Fertility medications: Drugs like Clomid or gonadotropins can help stimulate ovulation, helping to increase your chances of getting pregnant. These treatments can bring hope and possibility when trying to conceive has felt out of reach.
Surgical Options
In some cases, surgery may be suggested to improve fertility. While the decision to undergo surgery is personal, it can be an effective step, especially if you’re struggling with moderate to severe endometriosis.
The most common approach is laparoscopic surgery, a minimally invasive procedure commonly used to remove endometrial lesions, cysts, and adhesions that may be blocking conception.
Removing the endometriosis tissue and restoring the natural pelvic anatomy can lead to improved fertility outcomes. Not everyone with endometriosis will need surgery, but for some, it can make a meaningful difference in both symptoms and fertility outcomes.
Assisted Reproductive Technologies
When other treatments haven’t worked, assisted reproductive technologies (ART) may offer another option. These methods work by supporting or bypassing parts of the reproductive process that may be affected by endometriosis.
- IUI (intrauterine insemination) places sperm directly into the uterus during ovulation, increasing the chances of fertilization.
- IVF (in vitro fertilization) involves fertilizing an egg outside the body and transferring the resulting embryo into the uterus.
- IVM (in vitro maturation) involves maturing immature eggs outside the body before fertilization and transferring the resulting embryo into the uterus.
ART can be especially helpful if endometriosis has affected your fallopian tubes or ovarian function. At Roon, our fertility specialists emphasize a focus on personalized care so you can weigh your options based on your specific diagnosis, age, and treatment history when it comes to treatments like IVF.
Your Path to Parenthood with Endometriosis
Can you get pregnant with endometriosis? The answer is yes. Many people with endometriosis conceive naturally, though it can take more time, and sometimes additional medical support.
There’s a widespread misconception that endometriosis always causes infertility. In reality, outcomes vary. But according to Roon expert Dr. Jackie Wong, with the right care and evaluation, pregnancy is often possible.
If you’ve been trying to conceive without success, it’s a good idea to speak with a reproductive endocrinologist. An early fertility evaluation can help clarify how endometriosis may be affecting your reproductive health and whether treatments like ovulation induction, IVF, or fertility preservation might be appropriate.
The key is getting the right information early, so you can make informed decisions about next steps. Sign up for Roon today to get trusted answers to your healthcare questions from thousands of experts who can guide you every step of the way.
Frequently Asked Questions (FAQ):
What are the odds of getting pregnant with endometriosis?
The chances of getting pregnant with endometriosis depend on the severity of the condition. Many women with endometriosis do conceive naturally, with about 60-70% of them able to get pregnant on their own. However, those with more advanced forms of endometriosis may face additional hurdles. Every journey is unique, and with the right care and support, pregnancy is still very much possible.
Can a woman with endometriosis conceive naturally?
Yes, absolutely. Many women with endometriosis do conceive naturally, though the path may look different for each individual. While endometriosis can sometimes complicate the process, the majority of women can still achieve pregnancy, especially with lifestyle adjustments, medical guidance, and a supportive care team.
Can I have a baby if I have endometriosis?
Yes, women with endometriosis can have a baby. It's important to work closely with your healthcare provider to monitor your pregnancy and manage any symptoms. With proper support, many women with endometriosis go on to have successful pregnancies.
What age is best to get pregnant with endometriosis?
There's no one-size-fits-all answer to this question. Fertility can decline with age, and endometriosis may make conception more challenging as you get older. That said, it’s always a good idea to speak with a healthcare provider early on if you're thinking about expanding your family. With early planning and support, you can navigate your path to parenthood with confidence.
