Endometriosis and fertility: what you can have tested

If you have just heard that you have endometriosis and you want to have a baby, I understand that a lot of questions come rushing in at once. The picture that sticks online is often gloomy, while the reality is more nuanced and more hopeful.

In this article I set out what endometriosis can mean for your fertility, and what you can choose to have tested.

One thing first: blood tests do not diagnose endometriosis and do not measure how severe it is. They can give context around your wish to conceive, alongside the examinations done by your doctor.

You may feel like you are racing against the clock, or that a diagnosis suddenly makes your future smaller. Those feelings are understandable, and you do not have to push them away.

At the same time, it helps to know that many women with endometriosis simply conceive, sometimes without any help at all.

Does endometriosis affect your fertility?

Endometriosis can affect your fertility, but it does not for everyone. It is estimated that 30 to 50 percent of women with endometriosis experience reduced fertility, while 60 to 70 percent conceive naturally. So it is not an automatic diagnosis of infertility.

That nuance often disappears in alarming stories. The numbers paint a different and more hopeful picture.

Reduced fertility also does not mean the same as infertile. It can mean that conceiving takes a little longer on average, while for many women it still works in the end.

How much endometriosis affects your situation depends on the location, the extent and your personal story.

Your age and any other factors also play a role, just as they do for women without endometriosis. So endometriosis is rarely the whole story.

That is exactly why a conversation with your gynaecologist or fertility specialist is so valuable. Want the bigger picture first? Read our overview of endometriosis, symptoms and diagnosis.

How can endometriosis make conceiving harder?

Endometriosis can make conceiving harder in a few ways, especially in more extensive forms. Think of adhesions, affected ovaries or fallopian tubes, and an inflammatory response in the pelvis. In mild endometriosis the impact is often limited.

It helps to know that not every form has the same consequences.

• Adhesions: scar tissue can make organs stick together and reduce how well the fallopian tubes work.
• Affected ovaries or tubes: cysts or damage can disrupt ovulation or the transport of the egg.
• Inflammatory response: an inflamed environment in the pelvis may make fertilisation and implantation less favourable.

How strongly these factors play a role differs from person to person and cannot be read from a tube of blood.

In mild endometriosis the tubes and ovaries often keep working well, while the impact in deep endometriosis can be greater. The difference is genuinely personal.

Imaging and your doctor examination give far more direction here than any blood value.

What can you have tested with endometriosis and a wish to conceive?

With endometriosis and a wish to conceive, blood tests can give context, but they do not measure the endometriosis itself. AMH gives an impression of your egg reserve, and hormones such as FSH, LH, oestradiol and your thyroid sketch a picture of your cycle. Imaging and your gynaecologist decide the approach.

So what a blood test can and cannot do is an important distinction.

What blood tests can offer:

• An impression of your egg reserve through AMH (anti-Mullerian hormone).
• Context about your cycle through hormones such as FSH, LH and oestradiol.
• Insight into factors that play a role in fertility, such as your thyroid and possibly prolactin.

What blood tests cannot do:

• Diagnose or rule out endometriosis.
• Measure the severity or extent of endometriosis.
• Predict whether and when you will conceive.

A low AMH value, for example, does not automatically mean that conceiving will not work, and a normal value is no guarantee.

Some hormones are best measured at a fixed point in your cycle, often around the third day of your period. A doctor can tell you what is worth measuring in your situation, and when.

So see a result as a piece of the puzzle, not as a final verdict.

Want to understand what your result means for your age? Read our article on the AMH value by age, or read the broader explanation of fertility testing in women.

What treatment options are there when trying to conceive?

With endometriosis and a wish to conceive there are several options, depending on your situation. Often a watchful approach comes first, sometimes surgery is helpful, and in some cases IVF or another fertility treatment is considered. Your gynaecologist or fertility specialist makes this choice together with you.

Which route suits you is very personal.

1. Watchful waiting: because many women conceive naturally, the advice may be to give it some time first.
2. Surgery: in certain cases a procedure can help, for example to treat adhesions or lesions.
3. IVF or another fertility treatment: when conceiving does not happen, guidance through a fertility clinic can be an option.

Which approach is sensible depends on many factors and belongs with your doctor.

It can help to write down your questions beforehand, so you do not forget anything during an appointment. Think of questions about the impact of your endometriosis, the expected timeline and which steps make sense.

You are also allowed to look after yourself in this process. A wish to conceive with endometriosis can be emotionally heavy, and support from your partner, loved ones or a counsellor is then valuable.

So do not let an average story discourage you. Your journey is your own, and there is often more possible than you might first think.

Frequently asked questions

Does endometriosis make me infertile?

No, endometriosis does not automatically make you infertile. A large share of women with endometriosis conceive naturally. For some it may take longer or need more guidance, and that is best discussed with your gynaecologist or fertility specialist.

Can a blood test show endometriosis?

No, a blood test cannot show or rule out endometriosis and does not measure its severity. Blood tests can give context around your wish to conceive, for example about your egg reserve and hormones. The diagnosis of endometriosis runs through your GP and gynaecologist, usually with imaging.

Is it smart to test my AMH with endometriosis?

An AMH test can give an impression of your egg reserve, which may feel reassuring and give a sense of control. Do remember that AMH says nothing about the endometriosis itself and does not predict conceiving. Always discuss your result with a doctor.

Sources

1. Endometriose Stichting, information on endometriosis and fertility (2024).
2. Thuisarts.nl, information on endometriosis and trying to conceive (2024).
3. Dutch College of General Practitioners (NHG), guidance on endometriosis and subfertility (2023).
4. World Health Organization (WHO), endometriosis factsheet (2023).

Want a first impression of your hormones and egg reserve? Take a look at our fertility assessment, with a professional review by a doctor.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. Discuss trying to conceive with endometriosis with your GP, gynaecologist or fertility specialist.