If you’ve been trying to conceive without success and have a history of painful periods or chronic pelvic pain, there’s a question worth asking: could endometriosis be part of the picture? For millions of women, this condition quietly affects fertility long before it is ever diagnosed. At Hackensack CMIGS, Dr. Adam Shoman helps women in New Jersey understand exactly how endometriosis affects the reproductive system — and what can be done about it.
What Is Endometriosis?
Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, bowel, or bladder. Every month, this tissue responds to hormonal changes the same way the uterine lining does: it builds up, breaks down, and bleeds. But because it has nowhere to go, it causes inflammation, scarring, and adhesions over time.
According to the American Society for Reproductive Medicine, endometriosis affects approximately 10% of women of reproductive age. Among women experiencing infertility, that figure rises significantly — studies suggest endometriosis is present in 30 to 50% of women who struggle to conceive.
How Does Endometriosis Affect Fertility?
Endometriosis can interfere with conception through several mechanisms. These are not uniform across every patient — the type, location, and severity of the disease all play a role.
- Distortion of pelvic anatomy: Adhesions caused by endometriosis can alter the position of the ovaries and fallopian tubes, making it harder for an egg to travel to the uterus after ovulation.
- Fallopian tube obstruction: Scar tissue near the tubal openings can physically block sperm from reaching the egg.
- Impaired embryo implantation: Endometriosis creates an inflammatory environment in the uterus that may make it harder for a fertilised egg to implant and develop.
- Reduced ovarian reserve: Endometriomas — cysts on the ovaries filled with old blood — can damage the surrounding ovarian tissue, reducing the number of viable eggs available.
- Increased miscarriage risk: Some research suggests that endometriosis, particularly submucosal involvement, is associated with higher rates of early pregnancy loss.
It is worth noting that having endometriosis does not mean you cannot conceive naturally. Many women with mild to moderate endometriosis do become pregnant without intervention. However, a thorough evaluation is important if conception has not occurred after 6 to 12 months of trying.
Does Treating Endometriosis Improve Fertility Outcomes?
For many women, surgical treatment of endometriosis can meaningfully improve fertility outcomes — particularly when the disease is affecting pelvic anatomy or the uterine environment.
The strongest evidence exists for surgical treatment of submucosal and cavity-distorting fibroids associated with endometriosis, and for the removal of endometriomas. Multiple peer-reviewed studies have shown that laparoscopic excision of endometriosis lesions can improve clinical pregnancy rates in women who were previously struggling to conceive.
Excision surgery — which cuts lesions out completely including their root — is generally considered more effective than ablation (surface destruction) for improving fertility outcomes, as it achieves more complete removal of disease.
Endometriosis and Assisted Reproduction
For some women, surgical treatment alone may not be sufficient, and assisted reproductive technology (ART) such as IVF may be recommended. In these cases, Dr. Shoman works in coordination with reproductive endocrinologists to ensure endometriosis-related barriers to conception are addressed before or alongside fertility treatment.
The decision to proceed with surgery before IVF versus going straight to IVF is individualised. Factors such as the severity of the endometriosis, ovarian reserve, age, and prior treatment history all influence this recommendation.
When Should You Seek Evaluation?
If you have been trying to conceive without success and experience any of the following, a consultation with an endometriosis specialist is worth considering:
- Painful periods that disrupt daily life
- Chronic pelvic pain or pain during intercourse
- A prior diagnosis of endometriosis that has not been surgically treated
- Unexplained infertility after 6–12 months of trying
- Recurrent pregnancy loss
At Hackensack CMIGS, Dr. Shoman provides comprehensive evaluation including pelvic examination, transvaginal ultrasound, and MRI when appropriate. Definitive diagnosis is made through laparoscopic surgery with biopsy — which can often be combined with surgical treatment in the same procedure.
A Note on Hope
An endometriosis diagnosis is not a verdict on your fertility. With accurate diagnosis, appropriate surgical care, and a personalised treatment plan, many women with endometriosis go on to have successful pregnancies. The key is getting the right evaluation from a specialist who understands the condition deeply.
Frequently Asked Questions
Can I get pregnant naturally if I have endometriosis?
Yes — many women with endometriosis conceive naturally, particularly those with mild to moderate disease. Fertility outcomes depend heavily on the type, location, and severity of endometriosis.
Does endometriosis always cause infertility?
No. Endometriosis affects fertility in some women but not all. An estimated 30–50% of women with infertility have endometriosis, but many women with the condition conceive without difficulty.
Can surgery improve my chances of conceiving?
For many women, laparoscopic excision of endometriosis lesions has been shown to improve natural conception rates. The benefit depends on the extent of disease and individual factors discussed at consultation.
Should I have surgery before trying IVF?
This depends on the severity of your endometriosis, ovarian reserve, age, and other factors. Dr. Shoman will review your imaging and history and coordinate with your reproductive specialist to recommend the most appropriate path.
How is endometriosis diagnosed?
The only definitive way to diagnose endometriosis is through laparoscopic surgery with biopsy. Ultrasound and MRI can provide supporting evidence but cannot confirm the diagnosis on their own.
Does endometriosis come back after surgery?
Endometriosis can recur after surgery, but excision surgery has lower recurrence rates than ablation. Many patients remain symptom-free for years, especially when surgery is followed by hormonal management.
Medical Disclaimer: This blog is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. All content is written for general educational purposes. Individual medical situations vary — always consult a qualified healthcare provider before making any decisions about your health. If you are experiencing symptoms mentioned in this article, please seek evaluation from a licensed physician.
Dr. Adam Shoman, MD, FACOG, MBA, is the founder and lead gynecologist at Hackensack CMIGS. With extensive experience in minimally invasive gynecologic surgery, he specializes in treating complex conditions like endometriosis and fibroids using advanced technologies, such as the da Vinci Surgical System. Dr. Shoman is dedicated to patient-centered care and empowering women to take control of their health. He holds his medical degree from Alexandria University and completed his residency at Mount Sinai in New York. Dr. Shoman is a Fellow of the American College of Obstetrics and Gynecology (FACOG) and is certified in Healthcare Quality (CPHQ).
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