Endometriosis and fertility


Endometriosis is a common condition affecting women of reproductive age, especially women over 30 who have not yet had children. Mild endometriosis is often associated with infertility and more severe degrees of endometriosis will have a greater impact on your ability to conceive naturally.

What is endometriosis?

Endometrial cells line the uterus, and when they grow outside the uterus (almost always in the pelvis, including the ovaries) this is known as endometriosis.

Recent research has shown that in women with endometriosis, the eggs and subsequently the embryos created from those eggs are of poor quality. This means that your chances of becoming pregnant are less likely.

What are the symptoms of endometriosis?

Symptoms of endometriosis include:

  • pelvic pain
  • painful periods
  • pain during intercourse and premenstrual spotting

Some factors that might indicate a higher incidence of endometriosis include if the woman experienced early puberty (first period before the age of 11); advanced maternal age at first child birth; heavy and painful periods; long periods (longer than 5 days) or short cycles (less than 27 days between periods); or a family history with close relatives also having endometriosis.

How does endometriosis affect fertility?

It’s not always a straightforward answer. Some women experience severe endometriosis, which can impair egg quality and the egg’s ability to mature. It may also alter the anatomy of the fallopian tubes, thus preventing the egg and sperm from meeting. Others experience mild endometriosis, which in some cases is associated with infertility. How and why this happens isn’t known.

It’s important to remember that even women who struggle with endometriosis can still conceive naturally.

What causes endometriosis?

Whilst it is unclear exactly what causes endometriosis there are a few theories:

  • Retrograde (backward) menstruation: During menstruation some of the menstrual blood that carries endometrial tissue cells flows backwards along the fallopian tubes into the pelvis where the cells can then implant and grow.
  • Coelomic Metaplasia: Suggests that the cells lining the pelvic organs are able to change their structure and function to become endometrial cells when they are influenced by certain conditions. Triggers could include puberty or oestrogen surges.
  • Altered immunity: Suggests that endometriosis might arise from a change in your immune system’s ability to recognise the presence of endometrial tissue in abnormal locations and eliminate it.


Endometriosis and mental health

Research has linked endometriosis to an increased likelihood of anxiety or depression. The chronic pain associated with endometriosis can often become a cyclical link, in which pain can increase anxiety, and yet the anxiety can worsen endometriosis pain. If you think you might have endometriosis, and are struggling to cope, we encourage you to book an appointment with your family doctor or meet one of our fertility specialists.

Diagnosis of endometriosis

Diagnosis is often based on the symptoms you present with, along with recognising clinical signs upon physical examination.

Your doctor will take a detailed history and conduct a pelvic exam to identify the thickening of endometriosis behind the uterus. Doctors may also use an ultrasound to help identify any areas of concern consistent with endometriosis.

Endometriosis is often difficult to diagnose, and in order to confirm the diagnosis a minimally invasive procedure called laparoscopic surgery is required. This involves the surgeon looking inside the abdominal cavity through a small incision in the navel.

Stages of endometriosis

Endometriosis is often classified as mild, moderate or severe or recorded in surgical notes as stage or grade I - IV:

  • Mild or stage/grade I endometriosis appears as small patches or surface lesions scattered around the pelvic cavity. 
  • Moderate or stage/grade I or II endometriosis appears as larger widespread disease starting to infiltrate tissue and often found on the ovaries, uterosacral ligaments and Pouch of Douglas. Sometimes there is also significant scarring and adhesions.
  • Severe or stage/grade IV endometriosis affects most of the pelvic organs, often with distortion of the anatomy and adhesions.

Although these stages are useful, it’s important to note that the symptoms and pain experienced within each stage are not always consistent. It’s also important to be aware that each stage does not necessarily correlate to how badly endometriosis will affect a woman’s fertility or amount of chronic pain.

For example, a woman who has stage 1 endometriosis, could experience more pain than someone who has been diagnosed with stage 4 endometriosis. It is very much dependent on the individual.

Endometriosis treatment

Treatment for endometriosis may simply consist of medication in the form of tablets, nasal sprays or injections. Medication for endometriosis can suppress ovulation, delaying the chance of pregnancy. 

Surgical treatment by laparoscopy is the treatment of choice. This removes the disease and restores normal pelvic anatomy. This is a keyhole operation where the surgeon inspects the abdominal cavity through a small incision in the navel to confirm the diagnosis, and treats it at the same time.

In many cases you may conceive naturally after surgery, and may not need IVF. Laparoscopic surgery could also increase your chance of success with reproductive treatments.

When to see your doctor

Seek advice from your GP or a fertility specialist if you experience symptoms that might be due to endometriosis and are also having trouble conceiving naturally.

Meet our specialists.

Meet Melbourne IVF fertility specialists
Find out more about fertility surgery

For further information and support groups visit:

Watch A/Prof Jim Tsaltas' insights on endometriosis diagnosis in Australia:

How Endometriosis Could Be Diagnosed Earlier