Endometriosis is a chronic condition that can affect menstrual health, pelvic comfort, and fertility. However, having endometriosis does not mean that pregnancy is impossible.
At Longevity Fertility Centre, we provide individualized fertility and reproductive health care for women with endometriosis, with in-person and online appointments available in Calgary and Edmonton.
Understanding Endometriosis
Endometriosis occurs when tissue similar to the lining of the uterus is found outside the uterine cavity.
It most commonly affects structures within the pelvis, including the ovaries and surrounding pelvic tissues. Endometriosis can be associated with pain, inflammation, scarring, and fertility concerns.
Possible symptoms may include:
- Painful menstrual periods
- Chronic pelvic pain
- Pain during or after intercourse
- Pain with bowel movements or urination
- Heavy menstrual bleeding
- Ovarian endometriomas
- Difficulty conceiving
Symptoms can vary considerably from one person to another. Some women experience significant pain, while others may have relatively few symptoms and discover endometriosis during a fertility evaluation.
Endometriosis and Fertility
Endometriosis is associated with infertility, but its effect on fertility varies between individuals.
Depending on the location and extent of the condition, fertility may potentially be affected by inflammation, pelvic adhesions, changes in pelvic anatomy, fallopian tube involvement, or ovarian involvement. In more advanced cases, scarring may interfere with normal movement through the fallopian tubes and reproductive tract.
However, endometriosis is only one part of the fertility picture.
Other important factors include:
- Age
- Ovarian reserve
- Ovulation
- Fallopian tube health
- Previous pregnancies
- Previous pelvic or ovarian surgery
- Duration of infertility
- Partner semen parameters
- Other reproductive conditions
For this reason, treatment planning should focus on the individual rather than the diagnosis alone.
Endometriosis Does Not Mean You Cannot Become Pregnant
Many women with endometriosis are able to become pregnant.
Some may conceive without fertility treatment, while others may benefit from surgery, IUI, IVF, or another fertility strategy depending on their individual circumstances.
Current fertility guidance recognizes several possible approaches for people with endometriosis-related fertility concerns, including expectant management, surgery, and assisted reproductive treatment. The most appropriate choice depends on the individual situation.
Age, ovarian reserve, duration of infertility, previous treatment, and other fertility factors can all influence how quickly further evaluation or treatment should be considered.
How Is Endometriosis Diagnosed?
Endometriosis may be suspected based on symptoms, medical history, physical examination, and imaging.
Pelvic or transvaginal ultrasound is commonly used during evaluation, particularly when ovarian endometriomas or deeper forms of endometriosis are suspected.
Some patients may also undergo MRI or laparoscopic surgery depending on their symptoms, imaging findings, and clinical situation.
A normal ultrasound does not necessarily explain every cause of pelvic pain or infertility, so persistent symptoms should be discussed with an appropriate physician or gynecologist.
Our Approach to Endometriosis Fertility Care
Every patient with endometriosis has a different reproductive history.
During the initial consultation, we review your:
- Menstrual history
- Endometriosis symptoms
- Fertility history
- Previous pregnancies
- Previous surgeries
- Previous fertility treatments
- Laboratory investigations
- Ultrasound and imaging findings
- Current medications and supplements
- Current fertility goals
When available, we may also review investigations such as:
- AMH
- FSH and estradiol
- LH
- Progesterone
- TSH and prolactin
- Antral follicle count
- Pelvic or transvaginal ultrasound
- HSG or other tubal investigations
- Surgical reports
- Fertility clinic records
- Semen analysis
The goal is to understand the complete reproductive picture rather than focusing on endometriosis alone.
Endometriosis and Ovarian Reserve
Ovarian reserve deserves particular attention when endometriosis involves the ovaries.
An endometrioma is an ovarian cyst associated with endometriosis. Depending on the individual situation, ovarian endometriosis and previous ovarian surgery may be relevant when evaluating future fertility.
Important factors may include:
- AMH
- Antral follicle count
- Age
- Whether one or both ovaries are involved
- Previous ovarian surgery
- Recurrent endometriomas
- Current fertility goals
- Plans for IVF or fertility preservation
For patients concerned about ovarian reserve, these factors should be considered together rather than relying on a single AMH result.
Endometrioma Surgery and Fertility
Finding an ovarian endometrioma does not automatically mean that surgery is required.
Surgery may be appropriate for some patients depending on symptoms, cyst characteristics, previous treatment, fertility plans, and other medical considerations.
However, ovarian surgery also needs to be considered carefully when future fertility is important because procedures involving ovarian tissue may affect ovarian reserve.
The decision should therefore be individualized, particularly for women with:
- Low AMH
- Diminished ovarian reserve
- Endometriomas involving both ovaries
- Previous ovarian surgery
- Recurrent endometriomas
- Advanced reproductive age
A gynecologist or reproductive endocrinologist can help determine whether surgery, continued observation, or fertility treatment is the most appropriate next step.
Trying to Conceive Naturally With Endometriosis
Not every patient with endometriosis needs to proceed immediately to IVF.
For patients hoping to conceive naturally, the appropriate amount of time to continue trying depends on several factors, including:
- Age
- Ovarian reserve
- Fallopian tube health
- Whether ovulation is occurring
- Duration of infertility
- Previous surgery
- Severity and location of endometriosis
- Semen analysis results
For some people with mild endometriosis and otherwise reassuring fertility investigations, a period of expectant management may be reasonable. Current 2026 NICE fertility guidance includes expectant management among the possible strategies for selected people with endometriosis-associated fertility concerns.
When age, ovarian reserve, tubal disease, or other fertility factors make time more important, earlier referral to a fertility specialist may be appropriate.
Endometriosis and IUI
IUI may be considered in selected patients with endometriosis, particularly when fallopian tubes are open and there are no major additional fertility factors.
The decision to use IUI depends on factors such as age, ovarian reserve, duration of infertility, semen parameters, and the extent of endometriosis.
The updated 2026 NICE fertility pathway includes stimulated IUI as one possible option for selected patients with endometriosis-related fertility problems.
IUI is not appropriate for every patient, particularly when there is significant tubal disease or when other factors make IVF a more appropriate treatment.
Endometriosis and IVF
IVF may be considered when pregnancy has not occurred with other approaches, when significant additional fertility factors are present, or when age and ovarian reserve make treatment timing particularly important.
Endometriosis does not automatically mean that IVF is necessary.
For patients who do proceed with IVF, the fertility specialist will consider factors such as:
- Age
- AMH and antral follicle count
- Previous ovarian response
- Endometriomas
- Previous ovarian surgery
- Fallopian tube health
- Semen parameters
- Previous IVF treatment
The treatment plan should be individualized according to the overall fertility picture.
Hormonal Treatment When Pregnancy Is the Goal
Hormonal medications can be useful for managing endometriosis symptoms in patients who are not currently trying to conceive.
However, hormonal suppression by itself is not used to improve spontaneous pregnancy rates in patients who are actively attempting conception. NICE specifically recommends against offering hormonal treatment alone, or combined with surgery, for the purpose of improving spontaneous pregnancy rates in people with endometriosis who are trying to conceive.
Treatment therefore needs to reflect whether the immediate goal is symptom management, pregnancy, or both.
Fertility After Endometriosis Surgery
Previous surgery is an important part of fertility planning.
If you have undergone laparoscopic treatment for endometriosis or removal of an ovarian endometrioma, it may be useful to review:
- The surgical findings
- Location of endometriosis
- Whether one or both ovaries were involved
- Whether ovarian cysts were removed
- Fallopian tube findings
- Pelvic adhesions
- Current AMH
- Antral follicle count
- Time since surgery
- Current age and fertility goals
Repeat ovarian surgery deserves particularly careful consideration when ovarian reserve is already reduced.
A Personalized Fertility Plan
Endometriosis can affect fertility very differently from one patient to another.
A younger woman with normal ovarian reserve, open fallopian tubes, and relatively mild disease may require a very different fertility strategy from someone with bilateral endometriomas, previous ovarian surgery, low AMH, or several years of infertility.
For this reason, fertility planning should consider your:
- Age
- Reproductive history
- Ovarian reserve
- Ovulation
- Endometriosis history
- Ultrasound findings
- Previous surgery
- Fallopian tube health
- Fertility treatment history
- Partner fertility factors
- Current reproductive goals
The goal is to develop a plan based on your individual circumstances rather than treating every patient with endometriosis in the same way.
Frequently Asked Questions
Can I still get pregnant if I have endometriosis?
Yes. Endometriosis can make conception more difficult for some women, but it does not mean that pregnancy is impossible. Fertility depends on many factors including age, ovarian reserve, tubal health, severity and location of endometriosis, previous surgery, and partner fertility factors.
Does endometriosis always cause infertility?
No. Some women with endometriosis experience difficulty conceiving, while others become pregnant without fertility treatment.
Does the amount of pain tell me how severe my fertility problem is?
Not necessarily. Symptoms and fertility impact can differ substantially between individuals, which is why fertility assessment should consider reproductive investigations and history rather than pain alone.
Can endometriosis affect ovarian reserve?
Ovarian involvement and previous ovarian surgery may be relevant when evaluating ovarian reserve. AMH and antral follicle count can therefore be useful parts of fertility assessment in patients with ovarian endometriosis.
Does an endometrioma always need surgery?
No. Whether surgery is appropriate depends on symptoms, cyst characteristics, age, ovarian reserve, previous surgery, and fertility plans.
Do I need IVF if I have endometriosis?
Not necessarily. Current fertility guidance recognizes expectant management, surgery, IUI, and assisted reproductive treatment as possible options depending on the individual clinical situation.
Should I take hormonal medication if I am trying to become pregnant?
Hormonal medications may be useful for managing endometriosis symptoms, but hormonal suppression does not improve spontaneous pregnancy rates while actively trying to conceive.
Endometriosis Fertility Care in Calgary and Edmonton
If you have endometriosis and are trying to conceive, preparing for fertility treatment, have concerns about ovarian reserve, or would like a more detailed review of your fertility history, we can review your laboratory results, imaging, previous treatment, and reproductive goals.
In-person and online appointments are available in Calgary and Edmonton.