What Happens in Endometriosis?

In a normal menstrual cycle, the endometrial tissue inside the uterus thickens, breaks down, and sheds during menstruation. However, in endometriosis, the tissue that grows outside the uterus behaves similarly, thickening and breaking down. But, unlike the endometrial tissue in the uterus, this displaced tissue has no way to exit the body. It becomes trapped, causing inflammation, cysts, and scar tissue (adhesions).

Symptoms of Endometriosis

Endometriosis symptoms can vary widely among women. Some experience severe symptoms, while others have mild or no symptoms. Common signs of endometriosis include:

  • Painful Periods (Dysmenorrhea): Intense menstrual cramps that might begin before and extend several days into the period. Pelvic pain and cramping can also be felt in the lower back and abdomen.
  • Pain During Intercourse: Pain during or after sex is common with endometriosis. This pain is often described as deep rather than surface-level.
  • Pain with Bowel Movements or Urination: These symptoms occur during a menstrual cycle. The pain can be severe and debilitating.
  • Excessive Bleeding: Heavy menstrual periods (menorrhagia) or bleeding between periods (menometrorrhagia) are common in women with endometriosis.
  • Infertility: Endometriosis is often first diagnosed in some women who are seeking infertility treatment.
  • Other Symptoms: Fatigue, diarrhea, constipation, bloating, and nausea, especially during menstrual periods. These gastrointestinal symptoms can be confused with other conditions, such as irritable bowel syndrome (IBS).

The severity of symptoms is not necessarily an indicator of the extent of the condition. Mild endometriosis can be accompanied by severe symptoms, while advanced endometriosis can be asymptomatic. If you suspect you have endometriosis, consult our doctors for proper diagnosis and treatment.

How Endometriosis Affects Infertility

Endometriosis is a common cause of infertility, affecting up to 50% of women who struggle to conceive. There are several ways endometriosis can impact fertility:

1. Blockage of the Fallopian Tubes: If endometrial tissue grows on the fallopian tubes, it can block them. It prevents the egg from traveling from the ovary to the uterus, making fertilization difficult or impossible.

2. Ovarian Function: Endometriosis can form cysts on the ovaries, known as endometriomas. These cysts can damage the ovarian tissue and affect the quality and quantity of the eggs.

3. Pelvic Adhesions: Scar tissue or adhesions can form because of endometriosis. These adhesions can alter the structure of the pelvic organs, making it difficult for the egg and sperm to meet.

4. Inflammation: Endometriosis causes inflammation in the pelvic region. This inflammation can affect the function of the ovaries, fallopian tubes, and uterus, making it harder for fertilization and implantation.

5. Immune System Dysfunction: Endometriosis can alter the immune system, causing it to attack the embryo, making implantation difficult.

Diagnosing Endometriosis

Diagnosing endometriosis can be challenging. Symptoms often overlap with other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID). Doctors use several methods to diagnose endometriosis:

  • Pelvic Exam: During a pelvic exam, a doctor may feel for large cysts or scars behind the uterus.
  • Imaging Tests: Ultrasounds, MRI scans, or CT scans can help identify cysts associated with endometriosis.
  • Laparoscopy: The most definitive way to diagnose endometriosis is through laparoscopy. This minimally invasive surgery allows the doctor to see the endometrial tissue inside the pelvis and sometimes remove it.

What are the Treatment Options for Endometriosis-Related Infertility?

If you have endometriosis and are trying to conceive, several treatments can help improve your chances of getting pregnant:

1. Medications

While medications like birth control pills are used to manage endometriosis symptoms, they are not suitable for those trying to conceive. Instead, fertility medications like Clomiphene can stimulate ovulation.

2. Surgery

Laparoscopic surgery can remove endometrial tissue, cysts, and adhesions, improving fertility. This surgery can help restore the normal anatomy of the pelvis and increase the chances of natural conception.

3. Assisted Reproductive Technologies (ART)

For many women with endometriosis, assisted reproductive technologies like in vitro fertilization (IVF) offer the best chance of conception. IVF involves retrieving eggs from the ovaries, fertilizing them with sperm in a lab, and implanting the embryo into the uterus. IVF can bypass many of the barriers caused by endometriosis.

4. Superovulation and Intrauterine Insemination (SO-IUI)

It involves stimulating the ovaries to produce multiple eggs and then placing sperm directly into the uterus. This method can be effective for women with mild endometriosis and normal fallopian tubes.

5. Egg Freezing

For women who are not ready to conceive but have a declining ovarian reserve due to endometriosis, egg freezing can preserve fertility for future use.

How to Improve Your Chances of Conception?

While medical treatments are essential, lifestyle changes can also improve your chances of conceiving with endometriosis:

  • Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help reduce inflammation.
  • Regular Exercise: Moderate exercise can improve overall health and reduce stress.
  • Maintain a Healthy Weight: Being overweight or underweight can affect fertility. Aim for a healthy weight to optimize your chances of conception.
  • Reduce Stress: Stress can negatively impact fertility. Practices like yoga, meditation, and counseling can help manage stress.
  • Avoid Alcohol and Smoking: Both can impair fertility and exacerbate endometriosis symptoms.

When to Seek Help?

If you have endometriosis and have been trying to conceive for six months without success, it’s time to see a fertility specialist. Early intervention can improve your chances of conceiving. Our doctors can work with you to create a personalized treatment plan based on the severity of your endometriosis and other factors.

Final Thoughts

Endometriosis is a challenging condition that can significantly impact fertility. However, with the right treatment and lifestyle changes, many women with endometriosis can conceive and have healthy pregnancies. Understanding how endometriosis affects infertility is the first step towards managing the condition and seeking appropriate help.

If you’re struggling to conceive and suspect endometriosis, don’t hesitate to consult our doctors. Early diagnosis and treatment can make a significant difference in your journey to parenthood.


How does endometriosis affect conception? 

Endometriosis affects conception by causing inflammation, blocking fallopian tubes, forming cysts on ovaries, and creating scar tissue that alters pelvic anatomy. These issues can hinder egg and sperm meeting, fertilization, and implantation, making it harder to conceive.

When is the best time to get pregnant with endometriosis? 

The best time to get pregnant with endometriosis is as early as possible, ideally before the condition progresses. Women under 35 have higher fertility rates, so early intervention and consulting a fertility specialist can improve the chances of conception.

Does endometriosis affect implantation? 

Yes, endometriosis can affect implantation. Inflammation and an altered hormonal environment caused by endometriosis can make it difficult for the embryo to implant in the uterine lining, reducing the chances of a successful pregnancy.

Can endometriosis affect egg quality? 

Endometriosis can affect egg quality. The inflammation and oxidative stress associated with endometriosis may damage eggs, reducing their viability and potentially leading to difficulties in achieving and maintaining a pregnancy.

Are you a high-risk pregnancy if you have endometriosis? 

Yes, women with endometriosis have a higher risk of complications during pregnancy, such as preterm delivery, preeclampsia, placenta previa, and cesarean deliveries. Close monitoring and specialized care are essential to manage these risks.

Is PCOS or endometriosis worse for fertility? 

Both PCOS and endometriosis negatively impact fertility but in different ways. PCOS primarily affects ovulation, while endometriosis can cause anatomical and inflammatory issues. The severity of each condition varies individually, so it’s essential to consult a doctor for personalized assessment and treatment.