- Endometriosis affects fertility but is not the same as infertility.
- Surgery helps most in moderate–severe disease.
- AMH and age drive the sequencing decision.
How endometriosis affects fertility
Endometriosis reduces fertility through several mechanisms: mechanical distortion by adhesions, direct damage to ovarian reserve by endometriomas, inflammation altering tubal function, and impaired egg quality. Around 30–50% of women with endometriosis experience some infertility.
When surgery improves fertility
For stage III–IV disease and endometriomas over 4 cm, expert excision improves natural conception rates in the 12 months following surgery. For stage I–II disease, surgery gives a smaller absolute fertility benefit, and IVF may be a better first step depending on age and ovarian reserve.
The right order of decisions
In your late 30s or with borderline ovarian reserve (low AMH), the priority may be egg freezing or IVF before surgery, because ovarian reserve can drop after cyst removal. In your 20s or early 30s with good reserve, surgery-first is often the better plan. This decision should be individualised — never made from a single symptom score.
Frequently asked questions
Will removing an endometrioma lower my egg count?
Yes, slightly, especially with bilateral cysts. An expert surgeon minimises this by careful stripping and haemostasis technique.
Is IVF less successful with endometriosis?
Live birth rates are slightly lower per cycle, but IVF remains highly effective — cumulative outcomes over 2–3 cycles are close to those of women without endometriosis.
Should I freeze my eggs?
If you have low AMH or plan to delay pregnancy, egg freezing before endometrioma surgery is often wise.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation