Endometriosis and Female Infertility

Endometriosis and female infertility at a glance

  • Endometriosis, a common cause of infertility, is the spread of tissue that normally lines the uterus to the outside of the uterus.
  • Although many women can have this condition but not experience symptoms, the most common symptom is pelvic pain.
  • Infertility is also considered a potential symptom, but women often can become pregnant after treatment.
  • Possible treatment options are lifestyle changes, medication and surgery.

What is endometriosis?

Endometriosis is the spread of tissue that normally lines the uterus to the outside of the uterus, sometimes causing infertility, abdominal discomfort or even severe pain. It usually is not dangerous but it is a progressive disease and should be treated. The invading tissue from the endometrium may attach itself and grow upon any organ or structure within a woman’s pelvis, including the ovaries, which can lead to removal of one or both ovaries.

About 1 in 10 women and over five million American women have endometriosis. Experts do not know why some women develop this condition.

Endometrial tissue’s normal function involves a woman’s menstruation. When a woman ovulates and her egg is fertilized, the endometrium remains in place to aid in the embryo’s implantation in the uterus (womb). But if a woman ovulates and her egg is not fertilized, the endometrium is expelled from the body in menstrual discharge.

When this endometrial tissue is displaced to areas outside the uterus, it reacts by thickening, breaking down and bleeding during each menstrual cycle. This endometrial blood tissue cannot exit the body, and builds up. It becomes trapped and causes inflammation, pain and irritation. Endometriosis in the ovaries can cause ovarian cysts (endometriomas).

Causes of endometriosis

The actual cause of endometriosis is not understood. Scientists think that it may be triggered by retrograde menstruation, a condition in which menstrual blood combines with endometrial cells and flows back up the fallopian tubes and into the pelvic area instead of exiting the body through the vaginal canal.

If a woman has a hysterectomy or a caesarean section, endometrial cells can attach to and grow on the surgical incision resulting in endometriosis. Women are at greater risk if one or more relatives have had the condition, if they have a history of pelvic infections or abnormal uterine issues, or if they have never given birth.


Although many women with endometriosis are completely asymptomatic, the most common symptom is pelvic pain that is more severe during menses. The characteristic symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.

Symptoms can vary a great deal from woman to woman. In general, the deeper the location of the endometriosis the more pain a woman will experience. Additional symptoms that present during menstruation are constipation, diarrhea, fatigue and nausea.

Infertility is also considered a potential symptom, and in some cases endometriosis is not discovered until a woman is examined and tested for infertility.

How does endometriosis affect fertility?

Endometriosis, a common cause of female infertility, is a problem many women have during childbearing years. According to the American Society for Reproductive Medicine (ASRM), endometriosis is found in 35-75 percent of infertile women with no other diagnosed problem. However, many women with endometriosis become pregnant after treatment.

Although many theories have been proposed to explain how endometriosis is related to infertility, it is not completely understood. Generally it seems to mimic an inflammation, like an infection. The implants of endometriosis secrete factors that can interfere with eggs, sperm and embryos in animals. It is believed that humans experience similar effects.

Prevalence of endometriosis in the general population is unknown because many women can have the condition but not experience symptoms. Studies have estimated that approximately 5 percent of all women undergoing surgery for any gynecologic conditions have endometriosis. In those women undergoing surgery for pelvic pain, 12 to 32 percent have lesions, and in women having surgery for infertility, 21 to 48 percent have endometriosis.

Having endometriosis does not automatically mean that that a woman will experience difficulty having children. However, it may be harder for women to become pregnant. Endometriosis is a relative barrier to pregnancy but does not eliminate the prospect of a successful pregnancy.

How is endometriosis treated?

After a medical history review and pelvic exam, an outpatient surgical procedure called a laparoscopy is necessary to confirm a diagnosis of endometriosis. Possible treatment options are lifestyle changes, medication for both pain and hormonal regulation and surgery.

A physician’s advice on treatment is critical after diagnosis. If surgery is required, the disease is treated with lasers or electric current, which improve the odds of successful pregnancy.

Women with infertility caused by endometriosis may first try surgery, natural conception or insemination treatment. If these are not successful but the woman wants to have biological children of her own, the use of assisted reproductive technologies such as in vitro fertilization (IVF) may be considered. Some couples with long-term infertility or in older age groups may elect to ignore the possibility of endometriosis and skip the laparoscopy, moving to IVF right away.


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