Endometriosis and Infertility

Authors: Bulletti C, Coccia ME, Battistoni S, Borini A.

Publication: Journal of Assisted Reproduction and Genetics (2010) Aug;27(8):441-7.


Endometriosis is a wide-spread condition that affects 6-10% of general female population or 35- 50% of women with pain, infertility, or both. The range of endometriosis signs is very broad, and its symptoms are not disease stage dependent making diagnosis a challenge for both the patient and health care providers. Furthermore, endometriosis is commonly associated with debilitating period pain, chronic abdominal pain, and infertility. The link between endometriosis and infertility is poorly understood. However, there are several possible mechanisms of how endometriosis may lead to infertility:

Current treatments of endometriosis-associated infertility may involve medical therapies, surgical interventions, or both. The authors of this paper report that the best outcome in the absence of spontaneous post-surgery pregnancy, in their practice, was a combination of surgery and in vitro fertilization. However, the authors highlighted that all cases require a personalized management plan with a goal of both maximizing the treatment outcomes and minimizing the numbers of repeated surgeries. Factors that doctors will consider include female age, duration of infertility, duration of medical attention, pelvic pain, stage of endometriosis, family history, and male factors such as sperm count and semen quality.

Take home message:

Owing to the non-specific symptoms and lack of disease awareness, endometriosis is often mistaken for other conditions, such as inflammatory bowel syndrome. Unfortunately, ambiguous symptoms contribute to the diagnostic delay which can be detrimental for people seeking fertility care. Therefore, a multidisciplinary approach is recommended for improving diagnosis and reducing pain, improving quality of life, sexual activity, and fertility rates.

Work closely with your health care team to develop a personalized management plan for optimal treatment outcomes and minimize the numbers of repeated surgeries.

Endometriosis and infertility are two very active areas of research with new insights being added daily. Consequently, scientists and health care providers are continuing to make progress in identifying safe and effective treatment options for people with endometriosis and infertility. If you think you may have endometriosis or are struggling to achieve pregnancy, you are encouraged to seek care early and discuss your specific health care goals with your doctor to achieve the best outcome possible.