Yes — you can still get pregnant with endometriosis. Whether you were just diagnosed or you've been living with it for years, it helps to understand what endometriosis actually does to your fertility, and what your options look like for your specific situation. 

This article breaks it all down clearly so you know where you stand.

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of the womb grows in other parts of the body, most commonly in the pelvis, on or around the ovaries, fallopian tubes, and the lining of the abdomen.¹ Each month, this tissue reacts like the womb lining does during a period: it builds up and breaks down. But unlike a normal period, the blood and tissue have nowhere to go. Over time, this can lead to inflammation, scarring, and in some cases, structural changes to the reproductive organs.²

Endometriosis is estimated to affect around 1 in 10 women of childbearing age in the UK, and may affect as many as 2 million people.³

Symptoms:

Symptoms can vary widely from person to person. Common ones include:¹

• Severe period pain that stops you doing everyday activities

• Heavy periods

• Pain in your lower tummy or back (pelvic area)

• Pain during or after sex

• Pain when you poo or wee

• Extreme tiredness

• Difficulty getting pregnant

Some people have endometriosis with no symptoms at all, which is part of why it can take a long time to diagnose.

Causes:

The exact cause of endometriosis is not known.¹ There is thought to be a genetic link — you are more likely to develop it if a close relative has it.³ It mainly affects people during their reproductive years, from puberty through to menopause.¹

How does endometriosis affect chances of getting pregnant?

The link between endometriosis and fertility is still not fully understood. In some cases, endometriosis distorts the pelvic anatomy, narrowing or blocking the fallopian tubes or affecting how the ovaries function. For some people, endometriomas — cysts that form on the ovaries — can also reduce ovarian reserve, which may affect fertility.⁴

Most patients diagnosed with endometriosis have no problem getting pregnant.⁴ How much the condition affects fertility tends to depend on its severity, which is staged from 1 (minimal) to 4 (severe). 

Around 3 in 4 people with endometriosis have stage 1 or 2, ie. the minimal or mild form.⁴ That said, it is estimated that 60–70% of people with endometriosis can conceive naturally.² Even with severe endometriosis, natural conception remains possible. For mild to moderate endometriosis, the likelihood of natural conception is considerably higher than for more severe disease. If you have stage 3 or 4 endometriosis, you may need more medical support, but this does not rule out pregnancy.

What is the best age to get pregnant with endometriosis?

There is no single "right" age. But age is the single biggest factor in fertility for anyone, with or without endometriosis. Fertility declines naturally from your mid-30s, and the rate at which egg reserves deplete accelerates after 38.²

If you have endometriosis and are thinking about having children, the general guidance is not to delay if you can help it. The earlier in your reproductive years you try, the more likely natural conception is — and the more treatment options you have available if you need support.

You don't have to wait the standard 12 months of trying before being referred. Under NICE guidelines, having endometriosis is enough on its own to qualify for an earlier specialist referral — whatever your age. If you're 36 or over, that's an additional reason to be seen sooner.² If you are under 36, it is worth talking to your GP early, especially if you are concerned about your fertility.

How to improve pregnancy chances with endometriosis:

There are a number of things that can support your chances of conceiving, whether you are just starting out or have been trying for a while:

Laparoscopic surgery:

For superficial endometriosis (where tissue attaches to the lining of the pelvis), there is evidence that laparoscopic surgery, a keyhole procedure used to remove endometriosis patches, leads to better pregnancy rates and can improve the chances of natural conception.² Studies have shown it improves spontaneous pregnancy outcomes for stage 1 and 2 endometriosis specifically.⁴

For deep endometriosis (where it affects the bowel, bladder, or ureter), the research on surgery and pregnancy outcomes is more limited, and decisions are made on a case-by-case basis with a multidisciplinary team.

It is worth knowing that hormonal drug treatments, such as the contraceptive pill, do not improve fertility and are not recommended for people actively trying to conceive. They are used primarily for pain management.⁵

IVF (in vitro fertilisation):

IVF is an option for people with endometriosis who have not been able to conceive naturally or after surgery. Access to NHS-funded IVF in England depends on your local integrated care board (ICB), so availability varies by area.¹ Your GP or specialist can tell you what criteria apply locally and refer you accordingly.

If you are considering private IVF, it is worth having a detailed conversation with a fertility clinic about your specific diagnosis and stage of endometriosis, as this affects the approach.

IUI (intrauterine insemination):

IUI — where prepared sperm is placed directly into the uterus — is another option, sometimes used in combination with fertility medications. It tends to be considered earlier in the treatment journey for people with mild to moderate endometriosis, though its success rates are lower than IVF.

At-home solutions

For many people with endometriosis, particularly those with mild to moderate disease, trying to conceive naturally is the first step. There are practical tools that can support this process at home:

Lifestyle factors. Maintaining a healthy weight, eating a balanced diet, stopping smoking, and reducing alcohol intake are all steps that support reproductive health generally. Stress can also be a factor, so techniques like yoga, mindfulness, or counselling may help. It is worth having a conversation with your doctor about any lifestyle changes before starting to try.

Track your ovulation. Knowing when you are ovulating gives you the best chance of timing intercourse. Ovulation test kits can help with this — twoplus Fertility's ovulation test kit is designed to be simple to use at home and can help you identify your most fertile window.

Support sperm placement during intercourse. For some couples trying to conceive, making sure sperm reaches close to the cervix during intercourse can be a meaningful step. It may be worth considering as a step before moving to clinical treatments.

Improve your chances of pregnancy with twoplus Fertility

Trying to conceive can quickly start to feel like a chore. Timed sex, misaligned schedules, and even performance pressure often add up. The twoplus Applicator Extra takes that pressure off, so every fertile window becomes an opportunity again, not an obligation.

The twoplus Applicator Extra is a self-assisted artificial insemination kit that can be used from the comfort of your home. In just 3 simple steps, the Applicator Extra helps deposit sperm close to the cervix, giving nature a helping hand.

• No medical help or clinic visit needed

• Deposits semen close to the cervix, giving sperm a more direct path

• Designed for comfort with soft tip made of 100% medical grade silicone 

• Make your fertile window count

• Affordable alternative to try now: 3 steps. 15 minutes

Frequently asked questions

1. Does endometriosis always cause infertility?
   No. Many people with endometriosis conceive naturally. Endometriosis is associated with fertility difficulties, but it does not automatically mean you cannot get pregnant.

2. Is IVF available on the NHS for people with endometriosis? Access to IVF on the NHS depends on your local integrated care board (ICB). Speak to your GP about what is available in your area.

Sources

1. NHS. Endometriosis 

2. Endometriosis UK. Endometriosis, fertility and pregnancy

3. Hull University Teaching Hospitals NHS Trust. Endometriosis 

4. Bedfordshire Hospitals NHS Trust. Endometriosis patient information

5. Endometriosis UK. Endometriosis, fertility and pregnancy information pack