Endometriosis & Fertility: What You Need to Know

If you have endometriosis and you're trying to conceive, you've probably been given a lot of scary statistics. You may have been told to move quickly to IVF. You may be wondering if natural conception is even possible.

Here's what we want you to know: endometriosis does affect fertility, but it doesn't determine your outcome. Many women with endo conceive, both naturally and with assistance. And there's a lot you can do to improve your chances.

What Is Endometriosis?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. It's commonly found on the ovaries, fallopian tubes, and pelvic lining, but can appear elsewhere in the body.

This tissue responds to hormonal cycles just like the uterine lining does. It thickens, breaks down, and bleeds each month. But unlike menstrual blood, it has nowhere to go. This causes inflammation, scarring, and adhesions that can affect the pelvic organs.

Endometriosis affects an estimated 10% of women of reproductive age, though many go undiagnosed for years. Research published in the American Journal of Obstetrics and Gynecology found that the average time from symptom onset to diagnosis is seven to ten years. Many women discover they have endo only when they start trying to conceive.

Can You Get Pregnant with Endometriosis?

Yes. Many women with endometriosis conceive, both naturally and with treatment. The impact on fertility varies significantly depending on the location and severity of the disease.

Research published in Fertility and Sterility found that 60-70% of women with endometriosis are fertile. Among those who have difficulty conceiving, many go on to have successful pregnancies with treatment.

Understanding how endometriosis affects fertility helps you know what you're working with and where to focus your efforts.

How Does Endometriosis Affect Fertility?

Endometriosis can impact fertility through several mechanisms.

Inflammation affects the pelvic environment. The chronic inflammation associated with endo affects egg quality, embryo development, and implantation. A study in Human Reproduction found that inflammatory molecules in the pelvic cavity can affect eggs and sperm and interfere with fertilization.

Adhesions and scarring can distort anatomy. Scar tissue can block or damage fallopian tubes, preventing the egg and sperm from meeting. It can also affect the ovaries, making egg retrieval more difficult during IVF.

Endometriomas affect ovarian reserve. "Chocolate cysts" on the ovaries can damage ovarian tissue and reduce egg supply. Surgery to remove endometriomas can also affect reserve, which is why surgical decisions require careful consideration.

The uterine environment may be affected. Research in the Journal of Assisted Reproduction and Genetics suggests that endo can impact the uterine lining's receptivity to embryo implantation, even when the endometriosis is located elsewhere.

Egg quality may be compromised. The oxidative stress and inflammation associated with endo can affect the eggs developing in the ovaries.

The severity of symptoms doesn't always correlate with fertility impact. Some women with severe pain have mild disease that doesn't significantly affect fertility. Others have minimal symptoms but extensive disease affecting their reproductive organs. This is why proper evaluation is important.

What Are the Treatment Options for Endometriosis and Infertility?

Conventional treatment for endometriosis-related infertility typically involves surgery, medication, or assisted reproduction.

Laparoscopic surgery can remove endometrial implants, adhesions, and endometriomas. For some women, this improves fertility, particularly in the months immediately following surgery. A Cochrane review found that surgical removal of endometriosis increased spontaneous pregnancy rates compared to diagnostic laparoscopy alone. But surgery has limitations. It doesn't cure endo, which often recurs. And ovarian surgery can reduce reserve, which may be counterproductive for fertility.

Hormonal medications like birth control or GnRH agonists suppress endometriosis but also prevent pregnancy. They're sometimes used before IVF to quiet the disease, but they're not a fertility treatment themselves.

IUI (intrauterine insemination) can be effective for women with mild to moderate endometriosis, especially when combined with ovarian stimulation. It bypasses some issues by placing sperm directly in the uterus around ovulation.

IVF bypasses some of the mechanical issues caused by endo, like blocked tubes. Success rates for IVF with endometriosis vary depending on disease severity and other factors.

These approaches can be helpful. But they don't address the underlying inflammation, immune dysfunction, and hormonal imbalance that drive the disease. This is where integrative support makes a difference.

How We Treat Endometriosis for Fertility

At Fifth Avenue Fertility Wellness, we work with many women who have endometriosis. Our approach focuses on what conventional treatment often misses: reducing inflammation, supporting egg quality, regulating the immune response, and creating the best possible conditions for conception.

We address inflammation directly. Endometriosis is fundamentally an inflammatory condition. Through acupuncture, anti-inflammatory nutrition, targeted supplements, and lifestyle modifications, we work to reduce the inflammatory burden in your body. This supports egg quality, improves the pelvic environment, and may slow disease progression.

We support egg quality. The oxidative stress associated with endo can affect developing eggs. We use the same egg quality protocols we use for all our fertility patients: optimizing the ovarian environment during the 90-day window of egg development. For more on this, see our article on how to improve egg quality.

We regulate the nervous system. Chronic pain conditions like endometriosis often involve nervous system dysregulation. The pain itself creates stress, and stress amplifies pain. Acupuncture helps regulate the autonomic nervous system, reducing both pain and the stress response. When your nervous system settles, your body functions better overall.

We support hormonal balance. Endometriosis is an estrogen-dependent condition. While we can't cure endo, we can support healthy estrogen metabolism and hormonal balance through diet, liver support, and digestive health.

We manage pain. Many women with endo live with significant pain that affects their quality of life. Acupuncture is effective for endometriosis pain, and reducing pain also reduces the stress burden on your body.

Does Acupuncture Help Endometriosis?

Research supports acupuncture for endometriosis. A Cochrane review found that acupuncture was more effective than some conventional treatments for endometriosis-related pain. Studies published in Evidence-Based Complementary and Alternative Medicine have shown that acupuncture can reduce inflammatory markers like CA-125, which is often elevated in endometriosis.

For fertility specifically, acupuncture increases blood flow to the reproductive organs, supports egg quality, and helps regulate the hormonal environment. Research in the Journal of Endocrinological Investigation demonstrated measurable improvements in uterine and ovarian blood flow following acupuncture treatment.

We typically recommend weekly acupuncture for women with endometriosis who are trying to conceive, often starting several months before attempting conception or beginning treatment.

Best Diet for Endometriosis and Fertility

What you eat matters with endometriosis. An anti-inflammatory diet can help manage symptoms and support fertility.

Focus on vegetables, especially cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts that support estrogen metabolism. Include omega-3 fatty acids from fatty fish, flaxseeds, and walnuts. Research in Human Reproduction found that higher omega-3 intake was associated with lower risk of endometriosis. Choose clean protein and healthy fats. Minimize sugar, processed foods, alcohol, and inflammatory oils.

Some women with endo benefit from eliminating gluten and dairy, which can be inflammatory. A study in Minerva Chirurgica found that 75% of women with endometriosis reported reduced pain after 12 months on a gluten-free diet. This isn't necessary for everyone, but a trial elimination can reveal whether these foods are contributing to your symptoms.

Reducing exposure to endocrine-disrupting chemicals is also important. These are found in plastics, conventional personal care products, and pesticides. They can worsen hormonal imbalance and potentially fuel endometriosis.

If You're Considering IVF

Many women with endometriosis pursue IVF, either because of tubal damage or because other approaches haven't worked. If this is your path, preparation matters.

The months before your IVF cycle are an opportunity to reduce inflammation, support egg quality, and optimize your body's response to treatment. We work with many women preparing for IVF after an endo diagnosis, and we often see better responses after a period of focused preparation.

We also support women during IVF cycles with acupuncture around retrieval and transfer. For more on our IVF support, see our article on acupuncture and IVF.

What This Looks Like in Practice

A woman came to us at 33 with stage II endometriosis diagnosed two years earlier during a laparoscopy for painful periods. She and her husband had been trying to conceive for fourteen months. Her cycles were regular but painful, and she had deep fatigue in the week before her period. Her RE had suggested trying a few IUI cycles before considering IVF.

She wanted to optimize her chances before starting IUI. When we talked, she described living with low-grade pelvic discomfort most of the month, not just during her period. She had significant bloating that worsened after eating. She was a corporate attorney working long hours, often eating lunch at her desk and dinner after 9pm. Her sleep was disrupted by racing thoughts, and she described herself as running on caffeine and willpower.

We started working together two months before her first IUI. Weekly acupuncture focused on reducing inflammation and regulating her nervous system. We made dietary changes: eliminating gluten and dairy on a trial basis, adding anti-inflammatory foods, establishing regular mealtimes despite her schedule. We added targeted supplements for inflammation and egg quality.

Within the first month, her bloating improved significantly. Her pelvic discomfort decreased. She started sleeping better and noticed her energy was more stable throughout the day. By the second month, her period was noticeably less painful, requiring only ibuprofen on day one instead of the prescription medication she'd been using.

Her first IUI was unsuccessful. We continued the protocol and adjusted her herbs. Her second IUI cycle resulted in pregnancy.

She delivered a healthy baby boy at 34.

Read stories from women we've worked with →

Your Next Step

If you have endometriosis and you're trying to conceive, there's more you can do than wait for surgery or jump straight to IVF. Addressing inflammation, supporting egg quality, and optimizing your health can improve your fertility and your quality of life.

Learn more about our Fertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.