Pregnancy and Endometriosis: Can You Get Pregnant?
- drnanuradha
- 3 days ago
- 5 min read
Endometriosis and pregnancy are closely linked because endometriosis can affect fertility—but having endometriosis does not mean that pregnancy is impossible. Many women with endometriosis conceive naturally, while others may need medical or assisted reproductive treatment.
If you have been diagnosed with endometriosis and are planning a pregnancy, understanding how the condition can affect fertility and pregnancy can help you make informed decisions.
What is endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It commonly affects the ovaries, fallopian tubes, pelvic lining and other structures in the pelvis.
It may cause:
Painful periods
Chronic pelvic pain
Pain during intercourse
Pain during bowel movements or urination, particularly around menstruation
Difficulty conceiving
Ovarian endometriomas, sometimes called “chocolate cysts”
Endometriosis is associated with infertility in some women, although the severity of symptoms does not always predict the degree of difficulty in conceiving. Current guidelines emphasize individualized assessment rather than treating every woman in the same way.
Can you get pregnant with endometriosis?
Yes. Many women with endometriosis become pregnant.
However, endometriosis can sometimes reduce fertility through several mechanisms. Pelvic inflammation and adhesions may interfere with the normal function of the fallopian tubes and ovaries. Endometriomas and previous ovarian surgery can also affect ovarian reserve.
Age, ovarian reserve, severity and location of endometriosis, previous surgery, duration of infertility and the partner's fertility all need to be considered when planning treatment.
Therefore, a diagnosis of endometriosis should not automatically be interpreted as infertility.
Why can endometriosis make it harder to conceive?
Endometriosis may affect fertility in different ways.
1. Pelvic adhesions
Inflammation caused by endometriosis can result in scar tissue or adhesions. These may alter the normal relationship between the ovaries and fallopian tubes and interfere with egg pickup.
2. Ovarian endometriomas
Endometriosis can form cysts within the ovary called endometriomas. Depending on their size and location, they may affect ovarian function.
3. Inflammation
Endometriosis is associated with a chronic inflammatory environment in the pelvis. This may interfere with several steps involved in conception.
4. Reduced ovarian reserve
Both endometriosis itself and some ovarian surgeries used to treat endometriomas can affect ovarian reserve. This is particularly important when pregnancy is being delayed.
5. Age and other fertility factors
Endometriosis is only one part of the fertility picture. Age, ovulation, fallopian tube function and sperm quality also play important roles.
Should you try naturally or see a fertility specialist?
There is no single answer for every woman.
If you have endometriosis and are planning pregnancy, your doctor may assess:
Your age
Duration of infertility, if any
Severity and location of endometriosis
Presence and size of an endometrioma
Ovarian reserve
Ovulation
Fallopian tube status when appropriate
Previous endometriosis surgery
Partner's semen analysis
Your personal preferences and reproductive goals
The European Society of Human Reproduction and Embryology (ESHRE) recommends that fertility decisions in endometriosis be individualized, taking factors such as age, ovarian reserve, previous surgery, other infertility factors and the Endometriosis Fertility Index into account.
Does endometriosis always require surgery before pregnancy?
No.
Surgery is not automatically required simply because endometriosis is present.
For some women, surgery may be considered to treat significant pain or certain forms of endometriosis. In selected women with early-stage disease, surgery may improve the chance of ongoing pregnancy. However, surgery involving the ovaries must be carefully considered because ovarian surgery can potentially reduce ovarian reserve.
The decision should therefore be individualized rather than based only on the presence of an endometrioma or the stage of endometriosis.
What if I need IVF?
IVF may be considered when natural conception is unlikely, when infertility has persisted, when there are additional fertility factors, or when other treatment options are appropriate.
Importantly, having endometriosis does not mean that IVF will not work.
The decision to proceed with IVF depends on factors such as age, ovarian reserve, previous treatment, duration of infertility and the overall fertility assessment.
What happens once you become pregnant?
Many women with endometriosis have healthy pregnancies.
However, research suggests that some pregnancy and obstetric complications may occur more frequently in women with endometriosis. This does not mean that complications will occur in every pregnancy.
Your obstetrician may therefore recommend appropriate antenatal monitoring based on your individual history, rather than simply because you have endometriosis.
It is important to remember that pregnancy itself is not a treatment for endometriosis, and endometriosis can still require management after pregnancy.
Can endometriosis symptoms improve during pregnancy?
Some women notice that their endometriosis-related pain improves during pregnancy, particularly because ovulation and menstruation stop during pregnancy.
However, this is not guaranteed, and pregnancy should not be considered a cure for endometriosis.
Symptoms can return after pregnancy, particularly when menstrual cycles resume.
What if I have an endometrioma during pregnancy?
An ovarian endometrioma may sometimes be detected during an ultrasound examination in pregnancy.
Most ovarian cysts detected during pregnancy do not require immediate surgery. Management depends on factors such as:
Size of the cyst
Ultrasound appearance
Symptoms
Gestational age
Changes in the cyst over time
Suspicion of complications
Your obstetrician will determine whether observation or further evaluation is appropriate.
When should you seek help?
If you have known endometriosis and are planning pregnancy, it is reasonable to have a preconception consultation, particularly if you are older, have significant endometriosis, an endometrioma, previous ovarian surgery, reduced ovarian reserve or a history of infertility.
You do not necessarily need to wait a full year before discussing fertility with your doctor.
Early assessment can be particularly useful because fertility planning in endometriosis should take age and ovarian reserve into account.
A reassuring message for women with endometriosis
A diagnosis of endometriosis does not mean that motherhood is out of reach.
Some women with endometriosis conceive naturally. Others may need treatment to improve their chances of pregnancy. The important point is to avoid a one-size-fits-all approach.
If you have endometriosis and want to become pregnant, don't just ask, “Can I get pregnant?” Ask, “What is the best fertility plan for me?”
With appropriate evaluation and individualized care, many women with endometriosis go on to have successful pregnancies.
Take-home message
Endometriosis can affect fertility, but it does not equal infertility.
If you have endometriosis and are planning pregnancy:
Discuss your reproductive plans early.
Consider your age and ovarian reserve.
Assess other fertility factors when indicated.
Do not assume that surgery is always necessary.
Seek fertility treatment when appropriate rather than delaying unnecessarily.
Once pregnant, follow routine antenatal care with additional monitoring when clinically indicated.
If you have endometriosis and are planning pregnancy, consult your gynaecologist or fertility specialist for an individualized assessment and pregnancy plan.
This article is for general educational purposes and does not replace an individual medical consultation.
References:European Society of Human Reproduction and Embryology (ESHRE), Guideline: Endometriosis, 2022.American College of Obstetricians and Gynecologists (ACOG), Clinical Practice Guideline: Diagnosis of Endometriosis, 2026.
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