Medically reviewed by Dr. Thirumagal, MS (OG), LIVF Fertility & Women’s Healthcare · Updated November 2026
Quick answer: Endometriosis is a condition where tissue similar to the lining of the uterus grows outside it, often on the ovaries, tubes and pelvic lining. It can cause painful periods, pain during sex and difficulty conceiving. Many women with endometriosis do get pregnant, some naturally and some with help. The right plan depends on the stage of endometriosis, your age, your egg reserve (AMH), the condition of the tubes and your partner’s semen report.
What is endometriosis?
Every month, the lining of the uterus (endometrium) thickens and sheds as a period. In endometriosis, similar tissue grows outside the uterus, for example on the ovaries, fallopian tubes, the outer surface of the uterus, the bowel or the bladder. This tissue reacts to hormones too, which causes inflammation, pain and scar tissue (adhesions).
When it forms a cyst on the ovary filled with old blood, it is called an endometrioma, often called a “chocolate cyst” because of its dark brown fluid.
The WHO estimates that endometriosis affects about 1 in 10 women of reproductive age worldwide. Yet many women live with symptoms for years before a diagnosis, because severe period pain is often treated as “normal”.
What are the symptoms of endometriosis?
Symptoms vary a lot. Some women have severe pain with mild disease, and some have no pain at all and find out only during fertility tests.
- Painful periods that get worse over time or stop you from going to work or college
- Pelvic pain between periods or lower back pain
- Pain during or after sex, especially deep pain
- Pain while passing stools or urine, especially during periods
- Heavy or irregular bleeding in some women
- Tiredness, bloating and stomach upset around periods
- Difficulty getting pregnant
Period pain that does not settle with simple painkillers is not something to ignore. It is a good reason to see a gynaecologist.
How does endometriosis affect fertility?
Between about 30% and 50% of women with endometriosis have some difficulty conceiving. It can affect fertility in several ways:
| How it affects fertility | What happens |
|---|---|
| Adhesions and scar tissue | Can distort the tubes and ovaries so the egg and sperm cannot meet |
| Blocked or damaged tubes | Stops the egg from travelling to the uterus |
| Endometriomas (chocolate cysts) | Can damage nearby healthy ovarian tissue and lower egg reserve |
| Inflammation in the pelvis | May affect egg quality, sperm movement and embryo implantation |
| Pain during sex | Can reduce how often couples try during the fertile window |
The effect depends a lot on the stage. Doctors use stages from I (minimal) to IV (severe). Stage does not always match how much pain you feel, but it does guide fertility treatment.
How is endometriosis diagnosed?
- History and pelvic examination: your doctor asks about your periods, pain and how long you have been trying to conceive.
- Transvaginal ultrasound: good at finding endometriomas and some deep endometriosis. An expert scan is often the first step.
- MRI: used when deep endometriosis is suspected, or to plan surgery.
- Laparoscopy: keyhole surgery that lets the doctor see and treat endometriosis directly. Current guidelines no longer say every woman needs surgery to be diagnosed, so it is used when the result will change your treatment.
- Fertility tests: AMH test for egg reserve, a tube test such as an HSG, and the partner’s semen analysis.
A CA-125 blood test is sometimes raised in endometriosis, but it is not reliable enough to diagnose or rule it out.
Can I get pregnant with endometriosis?
Yes, many women can. With minimal or mild endometriosis, natural pregnancy is often possible, though it may take longer. With moderate to severe disease, blocked tubes or low egg reserve, treatment is more often needed.
A few points that help couples plan:
- Don’t wait too long. Endometriosis can progress, and egg reserve falls with age. If you know you have endometriosis and have been trying for 6 months, see a fertility specialist.
- Hormonal pills don’t improve fertility. Pills and other hormone treatments help with pain, but you cannot conceive while taking them, and guidelines do not recommend them as a way to improve pregnancy chances.
- Check egg reserve before ovarian surgery. Removing an endometrioma can lower AMH further, so discuss the plan with a fertility specialist first.
- Egg freezing can be an option for younger women with endometriomas who want to delay pregnancy. Read: Is Egg Freezing the Right Option for You?
Fertility treatment options for endometriosis
| Situation | Options your doctor may discuss |
|---|---|
| Minimal or mild endometriosis, open tubes, younger age | Trying naturally for a time, or laparoscopic surgery to remove endometriosis, then trying naturally |
| Minimal or mild endometriosis, not pregnant after trying | Ovulation stimulation with IUI |
| Moderate or severe endometriosis, damaged or blocked tubes | IVF, sometimes after surgery |
| Low egg reserve, older age, or male factor as well | IVF (with ICSI if needed) is often considered sooner |
| Severe pain affecting daily life | Pain treatment and surgery, planned around fertility goals |
Every couple’s plan is different. Your doctor will weigh pain, age, AMH, tube status and the semen report together before suggesting a path.
Frequently asked questions
Is endometriosis the same as PCOS? No. PCOS (now called PMOS) is a hormonal and metabolic condition that affects ovulation. Endometriosis is tissue growing outside the uterus that causes inflammation and scarring. A woman can have both. Read: PCOS Renamed to PMOS.
Does pregnancy cure endometriosis? No. Symptoms often feel better during pregnancy and breastfeeding because periods stop, but endometriosis usually remains and pain can return later.
Can endometriosis come back after surgery? Yes, it can recur, especially if hormone treatment is not continued in women who are not trying to conceive. This is why surgery is usually timed with your pregnancy plans.
Is a chocolate cyst dangerous? Most endometriomas are not cancer, but they need to be checked with a scan and followed up by your doctor. Whether to remove one depends on its size, your pain, your AMH and your fertility plans.
Does endometriosis affect IVF? Women with endometriosis can do well with IVF. Severe disease or low egg reserve may mean fewer eggs are collected, so doctors plan the stimulation and timing carefully.
At what age should I worry about period pain? At any age. Painful periods that stop you from studying, working or doing daily activities should be checked, even in teenagers.
The bottom line
Endometriosis is common, often missed, and can affect fertility, but it is not the end of the road. An early diagnosis with a good scan, an egg reserve check and a partner semen test helps you and your doctor choose between trying naturally, surgery, IUI or IVF. If you have painful periods and are planning a pregnancy, speak to a specialist early.
Living with painful periods or planning a pregnancy with endometriosis? Talk to our fertility team at LIVF Fertility & Women’s Healthcare. Book a consultation at our Perungudi centre, behind World Trade Center, OMR · +91 78787 84079. We see patients from Perungudi, OMR, Thoraipakkam, Kandanchavadi, Velachery and nearby areas.
References
- Becker CM, et al. ESHRE guideline: endometriosis. Human Reproduction Open, 2022.
- World Health Organization. Endometriosis – Fact sheet. who.int
- Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertility and Sterility, 2012.
- Zondervan KT, Becker CM, Missmer SA. Endometriosis. New England Journal of Medicine, 2020.
- National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management (NG73), updated 2024.
This article is for general information and does not replace advice from your doctor.
