Endometriosis and Infertility
If you've recently been diagnosed with endometriosis—or you're wondering whether it could be affecting your fertility—you may be feeling overwhelmed.
One of the first things many people do is search the internet.
Unfortunately, it's easy to come away believing that endometriosis automatically means you won't become a parent.
That simply isn't true.
Many people with endometriosis conceive naturally.
Others need fertility treatment.
Some never realise they have endometriosis until they begin investigating infertility.
Every journey is different.
Understanding how endometriosis can affect fertility is important, but so is remembering that a diagnosis is not a prediction of your future.
What Is Endometriosis?
Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the womb.
These growths are most commonly found around the ovaries, fallopian tubes and other pelvic organs, although they can occur elsewhere in the body.
Over time, endometriosis can lead to inflammation, scar tissue (adhesions) and changes within the pelvis.
Not everyone experiences symptoms in the same way.
Some people have severe pain.
Others have very little pain.
Some don't discover they have endometriosis until fertility investigations begin.
How Can Endometriosis Affect Fertility?
Doctors and researchers believe there are several ways endometriosis may affect fertility.
These include:
Inflammation
Endometriosis can cause ongoing inflammation within the pelvis.
Researchers believe this may affect the environment in which fertilisation and early embryo development take place.
Scar Tissue (Adhesions)
Endometriosis may cause scar tissue to develop.
Adhesions can alter the normal position of the ovaries, fallopian tubes and surrounding organs, sometimes making it more difficult for the egg and sperm to meet.
Damage to the Fallopian Tubes
In some cases, endometriosis may damage or block the fallopian tubes.
My own experience is an example of this.
After twenty years of infertility, I eventually discovered that I had bilateral hydrosalpinx—both fallopian tubes had become blocked and filled with fluid as a result of endometriosis.
Until then, I had no idea that endometriosis had been silently affecting my fertility.
Ovarian Endometriomas
Some people develop ovarian cysts associated with endometriosis, known as endometriomas.
Depending on their size and location, these may affect ovarian function or fertility treatment planning.
Does Everyone With Endometriosis Have Fertility Problems?
No.
Not at all.
Many people with endometriosis become pregnant without medical treatment.
Others may take a little longer to conceive.
Some require fertility treatment.
The severity of endometriosis doesn't always predict fertility.
Someone with mild disease may struggle to conceive, while someone with more extensive disease may become pregnant naturally.
Unfortunately, there isn't a simple rule.
When Should You Seek Help?
General guidance suggests speaking to your GP if:
you've been trying to conceive for around 12 months if you're under 35,
or around 6 months if you're 35 or older.
If you already have a diagnosis of endometriosis, or you have symptoms that concern you, it may be appropriate to seek advice sooner.
Your healthcare professional can advise you based on your individual circumstances.
My Story
For years, I believed I had unexplained infertility.
No one suggested endometriosis.
No one explained that it doesn't always present with severe pain.
By the time I discovered the true cause, both of my fallopian tubes had been irreversibly damaged.
I often wonder whether earlier investigation would have changed my journey.
I'll never know.
What I do know is this:
Endometriosis doesn't always look the way we expect it to.
Sometimes it whispers.
Questions Worth Asking
If you're worried about endometriosis and fertility, you might find these questions helpful during your appointment:
Could endometriosis be affecting my fertility?
Do my symptoms suggest any further investigations are appropriate?
Have my fallopian tubes been assessed?
Would seeing a fertility specialist be helpful?
If this isn't thought to be endometriosis, could you explain why?
If we're trying this treatment first, what would the next step be if it doesn't work?
Remember, these aren't questions designed to challenge your healthcare professional.
They're questions designed to help you understand your own care.
There Is Still Hope
Reading about infertility can feel frightening.
Statistics can make it seem as though your future has already been decided.
It hasn't.
Every fertility journey is different.
Some people conceive naturally.
Some need surgery.
Some need IVF.
Some build their families in other ways.
A diagnosis of endometriosis is not the end of your story.
It's simply one piece of information that helps you and your healthcare team decide what happens next.
A Gentle Reminder
Your body whispers before it screams.
Not every whisper means something serious.
But persistent symptoms deserve thoughtful conversations, informed questions and healthcare professionals who are willing to listen.
If something doesn't feel right, don't be afraid to ask again.