Endometriosis and Fertility: What You Need to Know

Endometriosis and Fertility: 1 Silent Journey, 1 Hopeful Answer

By Dr. Pereira

I still remember Shirley’s eyes—bright, curious, but carrying the quiet weight of a question no one had yet answered. She had been trying to get pregnant for three years. No pain, no heavy periods, no obvious signs. Just absence—of conception, of answers, of direction.

Like many women, she never suspected endometriosis. After all, isn’t it a disease of pain? Of doubled-over cramps, missed workdays, pain during sex? But Shirley had none of that. What she did have was infertility—relentless, unexplained, and heartbreaking.

Her case changed the way I talk about endometriosis and fertility with all my patients.

The Hidden Link Between Endometriosis and Fertility

Endometriosis and fertility are deeply connected, though not always in obvious ways. Endometriosis is often thought of as a painful menstrual disorder, but it can also exist silently, without symptoms, and still impact a woman’s ability to conceive.

In Shirley’s case, it was the subtle clues that pointed me in the right direction.

During her pelvic exam, I noted that her uterus was fixed in a retroverted position—tilted backward and seemingly stuck. It wasn’t a normal finding, and it raised my suspicion of something more complex going on.

I ordered a transvaginal ultrasound and an MRI.

The images revealed the truth.

Shirley had deep endometriosis involving both ovaries—large endometriomas, adhesions, and inflammation. It had silently wrapped itself around her reproductive organs, damaging the terrain without ever raising alarm bells. She had what we call “silent endometriosis.”

How Endometriosis Affects Fertility

1. Inflammation Creates a Hostile Environment

Endometriosis leads to chronic inflammation. This doesn’t just cause pain—it also changes the environment of the pelvis. The inflammatory fluid can damage eggs, sperm, and even embryos trying to implant.

In Shirley’s case, the inflammation wasn’t felt—but it was visible on her scans. Her ovaries were surrounded by dense tissue. The environment meant to nurture life had become a barrier.

2. Hormonal Imbalances Disrupt Ovulation

Women with endometriosis often have elevated estrogen and resistance to progesterone. This hormonal imbalance can disrupt ovulation and make the uterus less responsive to implantation.

Though Shirley’s cycles were regular, hormonal resistance may have made it harder for her body to support early pregnancy.

3. Scar Tissue and Adhesions Block Natural Conception

One of the most direct effects of endometriosis and fertility issues is physical. Scar tissue (adhesions) can block fallopian tubes or twist ovaries out of position. Endometriomas—chocolate cysts—can also damage healthy ovarian tissue and reduce egg reserve.

Shirley had large endometriomas on both ovaries. Her ovarian reserve was lower than expected for her age. Her fallopian tubes were distorted. She wasn’t ovulating efficiently, and even if she was, the egg and sperm may never have found each other.

4. Egg Quality Can Be Affected

Endometriosis increases oxidative stress in the pelvic environment, which can damage eggs. Even if ovulation occurs, the quality of those eggs might be compromised, reducing the chances of fertilization or early embryo development.

Diagnosis: The Moment That Changed Everything

What made the difference for Shirley was timing—but also a careful exam.

During the pelvic examination, I immediately noticed something abnormal. Her uterus wasn’t mobile—it was tilted backward, firmly adhered to deep pelvic structures. This wasn’t just a variation of normal. It was a red flag.

Right there in my office, I performed a transvaginal ultrasound.

There were no more doubts. Both ovaries were affected by endometriomas—large, dark cysts typical of advanced endometriosis. The ovaries were not free; they were stuck to the back of the uterus and also to loops of the bowel. The anatomy was distorted. Shirley’s case wasn’t just endometriosis—it was deep endometriosis.

To confirm the extent, I ordered an MRI.

The results matched exactly what we saw on ultrasound. The scan showed deep endometriosis in both uterosacral ligaments and also revealed a superficial lesion involving the bowel. Her uterus was completely fixed in retroversion, explaining the abnormal findings on exam.

For the first time, she had a name for the years of uncertainty: endometriosis and fertility were now connected in her story.

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Treatment Options and Fertility Planning

After confirming the diagnosis, my next step was to talk with Shirley about what this meant for her chances of becoming a mother.

She had been trying to conceive for over three years without success. Now we knew why.

The deep endometriosis involving both ovaries, the uterus, and even a segment of the bowel had silently affected her reproductive anatomy. The egg reserve might still be intact, but access was the issue. The inflammation, scar tissue, and endometriomas created both mechanical and biological barriers to conception.

I explained to her that in cases like this, natural pregnancy is still possible — but much less likely.

Given her age and how long she had already been trying, I recommended we act quickly. In-vitro fertilization (IVF) offered the highest success rate in her situation.

IVF would allow us to bypass the blocked fallopian tubes, retrieve eggs directly from the ovaries, fertilize them in the lab, and transfer a healthy embryo into her uterus — assuming we could prepare her uterine lining and control the disease beforehand.

But first, we needed to consider pre-IVF preparation:

• Suppression therapy to reduce inflammation and improve implantation rates.
• Careful monitoring of her ovarian reserve, especially due to the damage caused by the endometriomas.
• A surgical consultation, not for aggressive removal, but for gentle separation of adhesions if they interfered with egg retrieval or embryo transfer.

Shirley was quiet for a moment.

Then she asked the question I hear so often: “Will I ever be a mother?”

And the truth is — yes. Endometriosis and fertility may be linked by obstacles, but they are not mutually exclusive. With the right strategy, the right timing, and the right support, motherhood is still within reach.

Shirley left my office that day with a clear plan and something she hadn’t felt in years — hope.

A Path Forward: Hope, Choices, and Empowerment

n the days that followed, Shirley began her treatment. We started hormonal therapy to calm the disease activity and prepare her body for IVF. But more importantly, we gave her back control — something endometriosis had slowly taken from her.

She asked if pregnancy could still happen naturally.

In some women, it can.

If endometriosis is mild, if the fallopian tubes are open, if ovulation is regular, natural conception is absolutely possible. Many women conceive without needing IVF. But in Shirley’s case, deep infiltrating lesions, bilateral endometriomas, and three years of unsuccessful attempts all pointed toward a lower probability.

That’s why timing matters. Age plays a crucial role. After 35, fertility declines more sharply. And every year of delay due to undiagnosed endometriosis reduces the ovarian reserve, especially when the ovaries are affected.

Endometriosis and Fertility – What Can Be Done?

Shirley’s story is not unique. Many women face the heartbreak of infertility without answers.

But there are multiple treatment paths available, including:

Treatment Options for Endometriosis And Infertility

If you’re struggling to get pregnant, several options can help:

1. Medications to Reduce Inflammation and Balance Hormones

• Birth control pills, progestins, or hormone treatments can help control endometriosis symptoms.
• However, these treatments don’t improve fertility—they’re used more for symptom relief.  

2. Surgery to Remove Endometriosis Lesions and Scar Tissue

• Laparoscopic surgery can remove cysts, scar tissue, and other blockages that may be interfering with pregnancy.
• Many women see an increase in fertility after surgery, especially if their fallopian tubes are not affected​.  

3. Fertility Treatments (IUI and IVF)

If natural conception isn’t happening, doctors may recommend:

• Intrauterine Insemination (IUI): A procedure where sperm is placed directly into the uterus to improve the chances of fertilization.
• In Vitro Fertilization (IVF): A process where eggs are taken from the ovaries, fertilized with sperm in a lab, and then placed back into the uterus​.

IVF can be especially helpful for women with moderate to severe endometriosis, as it bypasses some of the barriers caused by scarring and inflammation.

Ways to Improve Fertility with Endometriosis

Even if you’re not undergoing treatment, there are steps you can take to support your fertility naturally, thought they are not a treatment:

Eat an Anti-Inflammatory Diet

• Focus on leafy greens, omega-3-rich foods (salmon, walnuts, flaxseeds), and whole grains.
• Avoid processed foods, sugar, and excessive dairy, which can trigger inflammation​.  

Manage Stress

• High stress can interfere with hormones that control ovulation.
• Activities like yoga, meditation, and acupuncture may improve relaxation and hormonal balance​.  

Stay Active but Avoid Overexercising

• Moderate exercise (walking, swimming, yoga) helps reduce inflammation and supports fertility.
• However, excessive exercise can disrupt ovulation, so it’s important to find balance.  

Consider Supplements

• Vitamin D, vitamin C, and antioxidants can help reduce inflammation and support reproductive health​.
• Talk to your doctor before starting any new supplements.  

Each plan must be personalized. Endometriosis and fertility are deeply interconnected — but no two cases are alike.

Endometriosis And Fertility – When to See a Doctor

If you’ve been trying to conceive for over a year (or six months if over 35), it’s time to speak to a specialist. And if you’ve ever experienced painful periods, bloating, pelvic pressure, or fatigue — don’t wait.

In Shirley’s case, she had none of the classic signs. No menstrual pain. No sexual pain. Just the silent erosion of her reproductive capacity.

That’s what makes endometriosis so dangerous: sometimes, it hides in plain sight.

If I had waited longer, if I hadn’t trusted the signs her body was showing me — a fixed uterus, immobile ovaries, a backward tilt during the pelvic exam — we might have missed our window.

But we didn’t.

Endometriosis And Fertility -The Outcome: A New Beginning

Months later, Shirley began her IVF cycle.

We retrieved several eggs — fewer than ideal, but enough. One beautiful embryo was transferred successfully. The wait was agonizing.

Then the call came.

She was pregnant.

It wasn’t just a medical victory. It was a triumph of timing, listening, and fighting for her chance. And when I saw her first ultrasound, tears came to her eyes — and mine too.

Not every journey ends this way. But every woman deserves the opportunity, the answers, and the compassion to find her path.

Endometriosis and fertility do not have to mean despair. With the right care, motherhood is still possible.

Endometriosis And Fertility – Conclusion

Endometriosis doesn’t mean infertility—but it can make conception more challenging. The good news is that many women with endometriosis go on to have healthy pregnancies, whether naturally or with the help of fertility treatments.

Understanding how endometriosis affects fertility, available treatment options, and lifestyle changes can help you take control of your reproductive health and increase your chances of conceiving.

If you’re living with endometriosis and struggling to conceive, you’re not alone — and it’s not your fault.

Early evaluation, individualized treatment, and emotional support can change everything.

Don’t accept pain or infertility as your destiny. Talk to a doctor. Ask questions. Get the care you deserve.

At vittafemme.com, we’re here to guide you every step of the way.

Endometriosis And Fertility – References

1. Latif, S., et al. Endometriosis and In Vitro Fertilization. Medicina 2024 .
2. Tsuei, A., et al. Comprehensive Management of Bowel Endometriosis : Surgical Techniques, Outcomes, and Best Practices. J. Clin. Med. 2025.
3. Dymanowska-Dyjak, I., et al. Oxidative Imbalance in Endometriosis-Related Infertility—The Therapeutic Role of Antioxidants. Int. J. Mol. Sci. 2024 .
4. Bayu, P., et al. Vitamin C and E Antioxidant Supplementation May Significantly Reduce Pain Symptoms in Endometriosis. PLoS ONE 2024 .
5. Chen, C., et al. Acupuncture for Clinical Improvement of Endometriosis-Related Pain: A Systematic Review and Meta-Analysis. Arch Gynecol Obstet 2024 .