The Effect of Endometriosis on Fertility

What is Endometriosis?

Endometriosis occurs when the layer of tissue that normally lines the uterus – the endometrium – is found in other parts of the body. Most commonly, this tissue is found on the ovaries and Fallopian tubes, but in rarer cases has been found on the bowels, liver, lungs, diaphragm, or even the brain. Although no one is sure exactly what causes endometriosis, some theories include:

  • Retrograde Menstruation – menstrual blood containing endometrial cells does not flow out of the body normally, but instead enters the abdominal cavity through the Fallopian tubes.
  • Surgical Scar Implantation – after a C-section, hysterectomy, or other surgery on the uterus, endometrial cells may attach to the incision.
  • Embryonic or Peritoneal Cell Transformation – hormonal or immune system factors transform these cells into endometrial cells.

Just as when it is found inside the uterus, this endometrial tissue is affected by monthly hormonal changes, meaning that it will swell, break down, and bleed as it normally would. With no place for this tissue to go, it can cause pain and ultimately create scarring and adhesions.

How Can It Affect My Fertility?

There are two main ways that endometriosis may cause fertility challenges:

  • Pain
  • Blockage or Damage to Reproductive Organs


There are different degrees of severity of endometriosis, and those levels are not always directly associated with pain. Some women who have mild cases of endometriosis experience debilitating levels of pain, while women with severe cases don’t experience much pain at all. It all depends on where the endometrial tissues has attached in the body. 

For many women, the pain associated with endometriosis is directly related to their periods, but some women experience pain during or after sex. This can have an obvious effect on a couple’s ability to conceive and may need medical intervention to overcome.

Blockage or Damage to Reproductive Organs

The most common places to find endometriosis is on the fallopian tubes or ovaries. Endometrial tissue in the fallopian tubes can prevent sperm from reaching the egg, the egg from traveling to the uterus, or in the event that the egg is fertilized can increase the risk of ectopic pregnancy. Endometriosis found on the ovaries can become a benign cyst called an endometrioma.

Depending on the severity, where it is located, and how long it goes untreated, endometriosis can cause the development of scar tissue and ultimately adhesions – fibrous bands of tissue that can cause different organs to get stuck together. These adhesions often cause pain distinct from the pain of endometriosis.

What Can I Do if I Think I Have Endometriosis?

If you have been experiencing severe pain associated with your period, experience pain during or after sex (or regularly with bowel movements or urination), or you have been struggling to get pregnant for six months to a year, it may be time to visit a fertility specialist. Diagnosis of endometriosis is done through minimally invasive laparoscopy.

Laparoscopy is a simple, outpatient procedure. Small incisions are made in the abdomen, and an endoscope – a small flexible camera – is inserted to directly examine the pelvic cavity, uterus, fallopian tubes, and ovaries. If endometriosis is identified, in many cases it can be treated immediately.

What Will Happen if I Have Endometriosis and I Get Pregnant?

If you have endometriosis and you do get pregnant, either with intervention or without, the symptoms of your endometriosis might actually improve. For the months that you are pregnant, the monthly hormonal fluctuations associated with menstruation will not occur. Your doctor will want to know if you have previously been diagnosed with endometriosis and may do some extra monitoring during your pregnancy. Because endometriosis can become more severe, some doctors may recommend not delaying pregnancy in case your symptoms and their effect on your fertility worsen.

What Do I Do Next?

Diagnosing endometriosis is a complicated process. The first step will most likely be a pelvic exam, followed by a transvaginal ultrasound, and finally – if appropriate – laparoscopy. Our fertility experts can help you understand what to expect throughout the process, as well as advise you on next steps depending on your family building goals. Contact us today for a free 30-minute consultation!