Endometriosis and Fertility: Symptoms, Diagnosis and Treatment Options
Endometriosis is a condition that can affect menstrual health, daily comfort and the ability to conceive. Some women experience severe period pain, while others may have few noticeable symptoms and discover the condition during a fertility evaluation. Understanding the connection between endometriosis and fertility can help women recognise possible warning signs and seek appropriate medical advice.
Recent research in India has also brought renewed attention to the condition. In September 2026, the Government of India reported findings from the country’s first genome-wide association study investigating genetic susceptibility to endometriosis. Although this research may improve scientific understanding over time, it does not mean that a routine genetic test can currently predict who will develop the condition.
For women planning a pregnancy, the important questions remain practical: What is endometriosis? How can it affect fertility? Which tests may be recommended? And when should treatment or fertility support be considered?
What Is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. These growths may occur around the ovaries, fallopian tubes, pelvic lining and other structures in the pelvis. In some cases, the condition can involve deeper tissues or organs.
Unlike the normal uterine lining, endometriosis lesions develop in locations outside the uterus. They can be associated with inflammation, pain, scar tissue and adhesions. The effects vary significantly between individuals.
The World Health Organization estimates that endometriosis affects approximately 10% of women and girls of reproductive age worldwide. The condition can influence physical health, emotional wellbeing and reproductive health.
Endometriosis is not simply a problem of painful periods. It is a medical condition that deserves evaluation when symptoms are persistent, severe or affecting quality of life.
What Are the Symptoms of Endometriosis?
Symptoms can differ from one woman to another. Some people have significant pain, while others experience mild symptoms or none at all.
Common symptoms include:
Severe menstrual cramps that interfere with everyday activities
Pelvic pain before, during or outside menstruation
Pain during or after sexual intercourse
Pain during bowel movements or urination, particularly around menstruation
Heavy or irregular menstrual bleeding in some individuals
Abdominal bloating, nausea or fatigue
Difficulty becoming pregnant
These symptoms are not exclusive to endometriosis. Other conditions, including adenomyosis, fibroids, pelvic inflammatory disease and gastrointestinal disorders, can cause similar problems.
When should you seek medical advice? Consider a consultation if period pain regularly disrupts work, education or daily life; pelvic pain persists; intercourse is painful; or you have concerns about fertility. Severe or sudden pelvic pain, especially with fainting, fever, vomiting or possible pregnancy, requires urgent medical assessment.
You do not need to experience every symptom to have endometriosis, and the severity of pain does not always indicate how extensive the condition is.
Can Endometriosis Cause Infertility?
Yes, endometriosis can contribute to infertility, but it does not mean that every woman with the condition will struggle to conceive. Many women with endometriosis become pregnant naturally, while others may need medical or fertility treatment.
The relationship between endometriosis and fertility is complex. Possible effects include:
1. Scar tissue and adhesions
Inflammation associated with endometriosis can contribute to scar tissue and adhesions in the pelvis. In some cases, these may alter the normal position or movement of the ovaries and fallopian tubes, making it harder for the egg and sperm to meet.
2. Ovarian endometriomas
Endometriosis can lead to cysts on the ovaries called endometriomas. Depending on the circumstances, these cysts and the condition affecting the surrounding ovarian tissue may be relevant to ovarian function and fertility planning.
3. Inflammation in the pelvic environment
Endometriosis is associated with inflammatory processes. These may influence reproductive functions, although the precise effects vary and are not identical in every patient.
4. Possible effects on egg and embryo development
Research continues to investigate how endometriosis may affect egg development, fertilisation and early embryo development. The impact can differ depending on the extent and location of the disease and other individual fertility factors.
5. Other fertility factors occurring at the same time
A woman with endometriosis may also have age-related changes in fertility, ovulation problems, tubal concerns or a partner with a sperm-related fertility issue. A complete assessment is important rather than assuming endometriosis explains every difficulty.
The presence of endometriosis alone cannot determine whether natural conception, IUI or IVF will be the most suitable approach.
Does Endometriosis Always Need Surgery?
No. Surgery is not automatically necessary for every woman diagnosed with endometriosis.
Treatment decisions depend on symptoms, the location and extent of disease, age, fertility goals, ovarian reserve, previous treatments and other clinical findings.
For some women, symptom management with medication may be appropriate. Hormonal treatments can help control endometriosis-related pain, but many suppress ovulation while being used and are not intended to improve the chance of natural conception during treatment.
Surgery may be considered in selected cases to address pain, anatomical problems or specific lesions. However, ovarian surgery can affect ovarian reserve, particularly when endometriomas are involved. Repeated ovarian operations may carry additional concerns.
For women who want to conceive, the decision to operate should therefore be made carefully. A fertility specialist and, when appropriate, an endometriosis surgeon can discuss the potential benefits, risks and alternatives.
The goal is not to perform the maximum number of procedures. It is to choose an approach that considers both the woman’s symptoms and her reproductive priorities.
How Is Endometriosis Diagnosed?
There is no single symptom or routine blood test that can reliably confirm or rule out every case of endometriosis. Diagnosis usually involves a combination of medical history, clinical assessment and appropriate imaging.
1. Medical history and symptom assessment
A doctor may ask about menstrual pain, pelvic discomfort, bowel or bladder symptoms, pain during intercourse, previous pregnancies, fertility history and family history. The timing and impact of symptoms can help guide further assessment.
2. Pelvic examination
A pelvic examination may be offered where appropriate. It can help identify certain abnormalities or areas of tenderness, but a normal examination does not exclude endometriosis.
3. Ultrasound
Pelvic ultrasound, including transvaginal ultrasound when suitable and acceptable, can help identify ovarian endometriomas and some forms of deep endometriosis. The quality of the assessment depends on the scan technique and the experience of the clinician.
However, a normal ultrasound cannot rule out all forms of endometriosis, particularly superficial disease.
4. MRI in selected cases
Magnetic resonance imaging may be recommended when additional detail is needed, especially if deep endometriosis is suspected or treatment planning requires more information.
5. Laparoscopy in selected situations
Laparoscopy is a surgical procedure that allows a clinician to examine the pelvis using a camera inserted through small incisions. It may be considered in selected cases, depending on symptoms, imaging results, treatment goals and clinical judgement.
It is not necessary for every patient before a treatment plan can be discussed. The appropriate diagnostic pathway should be individualised.
Can Women With Endometriosis Get Pregnant Naturally?
Yes. A diagnosis of endometriosis does not automatically mean that natural pregnancy is impossible.
The likelihood of conceiving depends on several factors, including age, ovulation, ovarian reserve, fallopian tube function, sperm health and the extent and location of endometriosis.
For some couples, a period of trying naturally may be reasonable after a medical assessment. Others may benefit from earlier fertility evaluation, particularly if they have been trying to conceive without success, have known ovarian endometriomas, or have significant pelvic disease.
It is important not to rely on symptom severity alone when making fertility decisions. A woman with mild pain may still have fertility concerns, while another with substantial pain may conceive naturally.
If pregnancy is a priority, discuss your reproductive timeline with a fertility specialist rather than postponing evaluation because the symptoms seem manageable.
Endometriosis and IVF: When May It Be Considered?
In vitro fertilisation (IVF) may be considered when endometriosis is associated with infertility, particularly when there are additional factors that make natural conception or other treatments less suitable.
During IVF, medications are used to stimulate the ovaries when appropriate. Eggs are collected and fertilised in a laboratory, and a suitable embryo may then be transferred into the uterus.
IVF may be discussed in situations such as:
Significant tubal damage or pelvic anatomical changes
Additional male-factor infertility
Previous fertility treatment that has not resulted in pregnancy
Fertility concerns where time is an important consideration
Individual clinical circumstances in which IVF is considered a suitable option
Not everyone with endometriosis needs IVF. Depending on the clinical picture, a specialist may discuss expectant management, surgery in selected cases, ovulation-related treatment or intrauterine insemination (IUI).
The decision should consider the woman’s age, ovarian reserve, previous surgery, endometriosis severity, partner’s fertility assessment and personal preferences. No single treatment is right for everyone.
Does Low AMH Mean Endometriosis Has Caused Infertility?
Not necessarily. Anti-Müllerian hormone (AMH) is one marker used to help assess ovarian reserve, which relates to the remaining pool of eggs. It does not independently measure egg quality or guarantee whether a woman will become pregnant naturally.
Some women with ovarian endometriomas or a history of ovarian surgery may have concerns about ovarian reserve. However, a low AMH result cannot by itself establish the cause of infertility or determine that pregnancy is impossible.
A fertility assessment may include AMH, antral follicle count on ultrasound, ovulation assessment when indicated, evaluation of the uterus and fallopian tubes, and semen analysis for the partner.
The results need to be interpreted together with age, medical history and reproductive goals. Treatment decisions should not be based on one laboratory value alone.
New Research in India: What Does the Genetic Study Mean?
n September 2026, the Government of India’s Press Information Bureau reported findings from India’s first genome-wide association study examining genetic susceptibility to endometriosis among Indian women.
Genome-wide association studies look for genetic variations that occur more frequently in people with a particular condition. Such research can help scientists understand biological pathways and investigate why some individuals may be more susceptible than others.
This is relevant because endometriosis is a complex condition, and diagnosis can be delayed when symptoms are dismissed or mistaken for ordinary period pain.
However, the findings should be interpreted carefully. Genetic associations do not prove that a particular gene directly causes endometriosis in an individual. They also do not establish a routine screening test or predict whether a specific woman will develop the condition.
The research does not replace symptom assessment, medical examination or appropriate imaging. Its value lies in improving scientific understanding and potentially informing future research.
For women experiencing symptoms or fertility concerns, the practical next step remains a clinical evaluation based on their individual history and needs.
When Should You See a Fertility Specialist?
Consider seeking a fertility evaluation if you have been trying to conceive without success, have known or suspected endometriosis, or have a history of ovarian endometriomas or pelvic surgery.
General guidance commonly recommends an infertility evaluation after 12 months of regular unprotected intercourse for women under 35, and after six months for women aged 35 or older. Evaluation may be appropriate sooner when there is a known condition associated with infertility. Women over 40 should generally discuss assessment promptly.
An evaluation can help clarify whether endometriosis is likely to be affecting fertility and whether other factors are involved. Both partners may need assessment.
You can also ask your doctor:
Could my symptoms be related to endometriosis?
Do I need a specialist ultrasound or other imaging?
Should my ovarian reserve and fallopian tubes be assessed?
Could surgery affect my future fertility?
Is trying naturally reasonable in my circumstances?
When should I consider IUI or IVF?
These questions can help you make informed decisions without assuming that one diagnosis determines your entire fertility journey.
Frequently Asked Questions
1. Can endometriosis cause infertility?
Yes, endometriosis can contribute to infertility through factors such as adhesions, tubal changes, ovarian endometriomas and inflammatory processes. However, many women with endometriosis conceive naturally.
2. Can I have endometriosis without severe period pain?
Yes. Some women have mild symptoms or no obvious symptoms. The absence of severe menstrual pain does not rule out the condition.
3. Can endometriosis be detected by ultrasound?
Ultrasound can identify ovarian endometriomas and some forms of deep endometriosis. However, a normal scan does not exclude all forms of the disease. Further evaluation depends on symptoms and clinical findings.
4. Is IVF always required for endometriosis-related infertility?
No. Treatment depends on age, ovarian reserve, tubal function, sperm health, disease severity and previous treatment. Natural conception, selected fertility treatments or IVF may be discussed according to individual circumstances.
5. Should an endometrioma be removed before IVF?
Not automatically. Surgery may be appropriate in selected circumstances, but ovarian surgery can affect ovarian reserve. A specialist should weigh the potential benefits and risks before recommending an operation.
6. Is there a genetic test to predict endometriosis?
The recent Indian research improves understanding of genetic susceptibility, but it does not establish a routine genetic test that can reliably predict an individual’s risk of developing endometriosis.
7. When should I seek help for endometriosis and fertility concerns?
Seek medical advice if pelvic pain or period pain affects daily life, or if you are having difficulty conceiving. Earlier assessment may be appropriate when endometriosis is already diagnosed or suspected.
Take the Next Step Towards Understanding Your Fertility
Endometriosis can affect women differently, and a diagnosis does not automatically mean that pregnancy will be difficult or impossible. Recognising symptoms, obtaining an appropriate evaluation and understanding the available options can help you make informed decisions about your reproductive health.
At Dr Archana IVF & Women Centre, Anna Nagar, Chennai, women and couples can discuss fertility concerns and the investigations or treatment options that may be appropriate for their individual circumstances.
If you are experiencing symptoms of endometriosis or have concerns about conception, consider arranging a consultation with a qualified fertility specialist.
Medical note: This article is for educational purposes and does not replace an individual medical assessment. Diagnosis and treatment decisions should be made with a qualified healthcare professional.