The Effect of Endometriosis on Women’s Fertility

A Guest Article by Silvia Hecher (LEVY Health)

Endometriosis is characterized by the presence of tissue that resembles the uterine lining but resides outside the uterus. These tissue accumulations are referred to as endometriosis foci, and they can affect all reproductive organs.

Nonetheless, scientists believe that endometriosis impacts fertility not solely due to the physical presence of tissue around the ovaries around the uterus. It also involves hormonal fluctuations, adhesions, scarring, inflammatory responses, and an overactive immune system, which can disrupt crucial processes necessary for a successful pregnancy. These processes encompass:

  • Ovulation
  • The transportation of the egg into the fallopian tube
  • The transfer of sperm cells to the mature egg cell
  • The implantation of the embryo in the uterus

How prevalent is endometriosis among women experiencing infertility?

Endometriosis stands as one of the most common gynecological conditions affecting women. Classic symptoms include severe menstrual pain and abdominal discomfort before or independently of menstruation. However, it is essential to note that endometriosis can manifest without noticeable symptoms.

Among women dealing with infertility, up to 50% may have endometriosis. In contrast, for women with untreated mild endometriosis, the monthly conception rate ranges from 2% to 4.5%, whereas healthy couples typically achieve rates of 15% to 20%, depending on age. For patients with moderate and severe endometriosis, monthly pregnancy rates drop below 2%.

It is crucial to recognize that these statistics represent averages. While some women with endometriosis may face years of trying to conceive, others may quickly achieve pregnancy.

How to achieve pregnancy with endometriosis?

Achieving pregnancy with endometriosis can be a significant challenge, particularly in cases of severe endometriosis. Surgical removal of endometriosis lesions and tissue can be a viable option to enhance fertility. However, the effectiveness of this approach can vary from person to person, and the decision to undergo surgical treatment should be made based on individual circumstances and needs. One crucial factor to consider is that endometriosis foci have the potential to regrow relatively quickly, emphasizing the importance of timing.

Surgical therapy is typically performed laparoscopically, involving minimally invasive procedures with tiny incisions. Surgical ablation, which entails the removal of tissue using heat, is commonly employed to eliminate endometriosis lesions. Depending on additional factors such as age, ovarian reserve, and uterine anatomy, assisted reproductive techniques (ART) like artificial insemination are often recommended. In cases of severe endometriosis, a combination approach may be necessary, involving surgical removal of endometriosis foci followed by artificial insemination.

What are the success rates associated with different treatment approaches?

Surgical treatment can effectively alleviate pain in a substantial percentage of women, ranging from 60% to 80%.

Furthermore, surgical intervention can potentially improve fertility and elevate pregnancy rates significantly. Numerous studies have reported up to 60% post-surgery pregnancy rates, and some individuals may opt for additional in vitro fertilization (IVF) treatments. Notably, women with moderate to severe endometriosis tend to achieve IVF success rates comparable to those without endometriosis.
Acknowledging that a woman’s age and ovarian reserve, assessed through anti-Müllerian hormone levels, play a pivotal role in determining the likelihood of pregnancy.

However, conducting a comprehensive fertility evaluation before embarking on endometriosis treatment is crucial. Many women with endometriosis may also face other factors that can impact fertility.

Fertility Analysis at LEVY Health

LEVY Health offers a customized fertility assessment for women aspiring to conceive but encountering obstacles. It is particularly valuable for women who have received a diagnosis of endometriosis or suspect they may have the condition, as it delves into the root causes of infertility, facilitating the selection of the most suitable treatment options. The fertility assessment at LEVY Health encompasses a thorough examination, including a detailed medical history, an evaluation of individual circumstances, and personalized diagnostics tailored to each woman’s unique situation. Following the evaluation, customized treatment recommendations are provided.

Commence your fertility assessment by clicking here.


  • Centini G et al: Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate. J Minim Invasive Gynecol. 2016;23(1):113-119.
  • Ballester M, Oppenheimer A, d’Argent EM, et al. Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod. 2012;27(2):451-456.
  • Keresztúri A, Kozinszky Z, Daru J, et al. Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery. Biomed Res Int. 2015;2015:282301.
  • (Zugriff im Januar 2022)

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