How Endometriosis Can Cause Infertility

Understanding the causes and current treatment options

Endometriosis is a condition where the lining of the uterus (endometrium) grows outside of the uterus. It is an abnormal and often painful disorder that affects anywhere from 6 percent to 10 percent of women. More concerning yet is the fact that it can lead to infertility in as many as 30 percent to 50 percent of those affected.

The overgrowth of tissue is only part of the reason why endometriosis interferes with fertility. Fortunately, there are treatments that can help.

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Understanding Endometriosis

The endometrium is the superficial lining of the uterus whose role it is to provide a place for a fertilized egg to implant. During the course of a woman's cycle, the lining will thicken in preparation for an embryo. If pregnancy doesn't occur, the lining breaks down and is shed during menstruation.

With endometriosis, the lining will grow beyond the uterus. This overgrowth of tissue primarily forms in the pelvic region on or around the ovaries. It can also develop less commonly near the rectum, vagina, fallopian tubes, or even in the urinary or gastrointestinal tracts. In rare instances, it may form in farther reaches of the body, including in the lungs, arms, or thighs.

Even though this tissue overgrowth is well outside of the uterus, it is still governed by the same hormonal changes of the menstrual cycle. As such, it will thicken, break down, and bleed. Yet, unlike the endometrial lining of the uterus, these tissue deposits can't be expelled vaginally. Instead, they build up over time and form cysts, adhesions, and scar tissue.

Symptoms of endometriosis can include:

  • General pelvic pain, even when not menstruating
  • Painful periods
  • Painful intercourse
  • Heavy periods or spotting between cycles
  • Irregular cycles
  • Painful urination and bowel movements, especially during your period

One of the more distressing aspects of endometriosis is the increased risk of infertility. Even women who experience no outward symptoms may only learn they have endometriosis during the course of an infertility evaluation.

How Endometriosis Causes Infertility

While endometriosis is thought to be involved in 30 percent of infertility cases, it is still not entirely clear how they are connected.

While it might be fair to assume that the development of adhesions and scarring can directly interfere with conception, infertility can result even in women where there is no obvious obstruction.

Known and Suspected Causes

  • Tissue overgrowth around the ovaries may prevent an egg from entering the fallopian tubes.
  • Endometrial overgrowth in the ovary may prevent ovulation from occurring.
  • Endometriosis may form inside the fallopian tubes, preventing the egg and sperm from meeting.
  • Research suggests that women with endometriosis have low levels of human chorionic gonadotropin (hCG), a hormone vital to maintaining pregnancy.
  • Endometrial cysts produce chemicals and other substance that are strongly linked to a lower density of ovarian follicles from which mature eggs are released.

Even from the point of view of trying to conceive, endometriosis can make sexual intercourse painful, if not unbearable, in some women. Moreover, the pain tends to only worsen during ovulation.

Treating Infertility in Women With Endometriosis

Treating infertility in women with endometriosis typically involves either the removal of tissues interfering with conception, the use of traditional assisted reproductive techniques, or both.

Common Treatment Options

  • Laparoscopic surgery can be used to remove endometrial overgrowth while retaining ovary function. This is not a “cure” per se, as endometriosis may return later. However, some women will experience increased fertility for up to nine months following surgery.
  • In vitro fertilization (IVF) may be an option for some women without the need to undergo laparoscopic surgery. For others, it may be used in conjunction with surgery.
  • Intrauterine implantation (IUI), along with fertility drugs, may also be considered an option for women with mild to moderate endometriosis.

If painful intercourse is a significant barrier to conceiving, the surgical removal of tissue overgrowth will almost certainly provide relief.

Success rates vary and depend largely on how far the disease has progressed. Women with mild to moderate endometriosis tend to have greater success following surgery than those with advanced disease.

If surgery proves unsuccessful in either case, IVF remains a strong option.

A Word From Verywell

If you have endometriosis, it is best to have it evaluated if you and your partner are planning to conceive. On the other hand, if you are having infertility issues and have not been diagnosed, discuss the option of having a laparoscopic evaluation with your gynecologist or fertility specialist. Our Doctor Discussion Guide below can help you start that conversation.

It’s important to remember that not every woman with endometriosis will have trouble conceiving. If and when you do get pregnant, having endometriosis won’t generally affect the pregnancy. In fact, hormonal changes caused by pregnancy can often lessen symptoms and progression of the disease, albeit temporarily.

Endometriosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Acién P, Velasco I. Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol. 2013;2013:242149. doi:10.1155/2013/242149

  2. Agarwal N, Subramanian A. Endometriosis - morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2(1):1-9. doi:10.4103/0974-2727.66699

  3. NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. What are the symptoms of endometriosis? Last reviewed January 31, 2017.

  4. Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441-7. doi:10.1007/s10815-010-9436-1

  5. Fadhlaoui A, Bouquet de la jolinière J, Feki A. Endometriosis and infertility: how and when to treat?. Front Surg. 2014;1:24. doi:10.3389/fsurg.2014.00024

Additional Reading
  • Bulleti, C.; Coccia, M.; Battistoni, S.; et al. Endometriosis and infertility. J Assist Repro Genet. August 2010: 27(8):441-447. DOI: 10.1007/s10815-010-9436-1.

By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is the author of "The Doula Advantage" and "Birth Plans for Dummies," and a member of the Association for Health Care Journalists. She has contributed to Reuters Health, USA Today, and more.