The Short Answer (Key Takeaways)

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• Endometriosis can reduce fertility, but it is not the same thing as infertility. Many women with endometriosis conceive, with or without medical intervention.
• Fertility outcomes depend on a complex combination of factors including disease subtype, inflammation, ovarian reserve, pelvic anatomy, and endometrial receptivity.^1-4
• The Endometriosis Fertility Index (EFI) is one tool used to estimate pregnancy likelihood after surgery, but it doesn't tell the whole story.³
• Pregnancy with endometriosis may carry increased risks for certain obstetric complications, which is why coordinated, ongoing care matters.
• July Health's interdisciplinary model combining nurse practitioner care, registered dietitian support, and therapy is aligned with this new standard of whole-picture endometriosis management.

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Does Having Endometriosis Mean I Can't Get Pregnant?

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This is one of the most common and understandable fears among women living with endometriosis and it deserves a clear, evidence-based answer.

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No. Endometriosis does not automatically mean infertility.

The research does show that endometriosis is associated with reduced fertility, but many women with endometriosis go on to conceive, and the picture varies widely depending on the individual. The problem is that this nuance rarely makes it through to the public. Instead, a widespread myth has taken hold: that an endometriosis diagnosis means you cannot have children. That belief causes real harm. It drives unnecessary fear, delays in seeking reproductive care, and decisions made from misinformation rather than evidence.

The truth is more complicated, and ultimately more hopeful than popular wisdom suggests.

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What Does the Research Actually Say About Endometriosis and Fertility?

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Endometriosis-associated fertility challenges arise from a complex interplay of factors: disease subtype, chronic inflammation, changes to pelvic architecture, lesions on or near the ovaries, reduced ovarian reserve, compromised endometrial receptivity (the uterus's ability to support implantation), and broader systemic effects of the disease.^1-4

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One tool clinicians can use to help estimate fertility outcomes after endometriosis surgery is the Endometriosis Fertility Index (EFI) a post-surgical prognostic score designed to predict the likelihood of spontaneous pregnancy without IVF.³ Research has found that women scoring above 5 on the EFI had a pregnancy rate of approximately 50% over 12 months, while women scoring below 4 had a rate closer to 12%.³ This gives patients and clinicians a meaningful data point but it's a starting place, not a verdict.

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Another study underscores this complexity, indicating that no single factor drives fertility outcomes in endometriosis.⁴ It is a combination of variables unique to each person's disease presentation and overall health picture. This is precisely why a one-size-fits-all treatment model doesn't work and why individualized, comprehensive care is necessary.

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Does Endometriosis Affect Pregnancy Beyond Conception?

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Yes, and this is an area that deserves more attention than it typically receives.

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Research on pregnancy outcomes in women with endometriosis has found increased risks of complications including pre-eclampsia, preterm birth, and placenta previa, among others.^5,6 This suggests that the impact of endometriosis on reproduction isn't limited to conception but may even affect how a pregnancy unfolds.

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This doesn't outright mean that pregnancy is dangerous for women with endometriosis, but it does mean that proactive, informed care throughout the reproductive journey matters. Understanding your individual risk profile, having a care team that takes your history seriously, and planning ahead all make a measurable difference.

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How Is Endometriosis Diagnosed?

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For decades, laparoscopy, a surgical procedure, was considered the definitive standard for diagnosing endometriosis. This created a significant bottleneck: women often waited years for a diagnosis because surgery was required to confirm what they were experiencing. That delay has real consequences for fertility, since untreated endometriosis can continue to affect ovarian reserve and pelvic anatomy over time.

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In February 2026, the American College of Obstetricians and Gynecologists (ACOG) released Clinical Practice Guideline No. 11, specifically aimed at shortening the time to diagnosis and improving access to care.⁷ The updated guidance is significant:⁷

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• Transvaginal ultrasound is now recommended as first-line imaging for endometriosis.
• MRI is reserved for cases where additional characterization is needed.
• Biomarkers are not recommended for diagnosis.
• Laparoscopy is no longer a prerequisite to receiving a diagnosis or starting treatment.

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Clinicians can now begin treatment based on symptoms and clinical evaluation. For women hoping to preserve or pursue fertility, this is a meaningful change. It means earlier intervention, earlier treatment, and less time living with unmanaged disease that may be silently affecting reproductive health.

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How Can I Support my Mental Health While Navigating Endometriosis and Fertility?

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If you've been reading along on the July Health blog, you may have already come across our articles on central sensitization and mental health support for endometriosis and if you haven't, we'd encourage you to explore them. The psychological dimension of this disease is not separate from the physical one. They are deeply connected.

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For women navigating fertility concerns alongside endometriosis, the emotional weight is significant. Anxiety about conception, grief over pregnancy losses, the strain of medical appointments and uncertainty, and the persistent nature of chronic pain all accumulate. Research consistently shows that untreated psychological distress can amplify the experience of pain and affect overall health outcomes which is why mental health support isn't a "nice to have" in endometriosis care. It's a clinical necessity.

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At July Health, our therapists work alongside our nurse practitioners and registered dietitians because we know that managing endometriosis well means managing the whole person not just the lesions.

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What Should I Know If I Have Endometriosis and Want to Get Pregnant?

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Here's what the evidence supports:

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1. Start care early

‍With updated ACOG guidelines making earlier, non-surgical diagnosis possible, there's no reason to wait for a laparoscopy to begin addressing your symptoms and building a care plan. Earlier management means better protection of ovarian reserve and overall reproductive health.

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2. Get individualized assessment

‍Tools like the EFI are useful, but they're one data point in a larger picture. A knowledgeable provider can help you understand what your specific disease presentation means for your fertility and what your options are.

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3. Don't navigate obstetric risk alone

‍If you're pregnant or planning to become pregnant, make sure your care team is aware of your endometriosis history. Monitoring for complications like pre-eclampsia and preterm birth is part of proactive pregnancy care for women with endometriosis.

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4. Address mental health proactively

‍Fertility journeys are emotionally complex even without a chronic illness in the picture. With one, professional support can make a profound difference both in how you experience the process and in your overall wellbeing.

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5. Nutrition matters

‍Inflammation is central to endometriosis pathophysiology, and diet plays a real role in modulating inflammatory load. A registered dietitian with endometriosis expertise can help you build a nutritional approach that supports both symptom management and reproductive health.

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How Can July Health Help with Endometriosis and Fertility?

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July Health was built for exactly this kind of complexity.

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We offer nurse practitioner services for women with endometriosis including symptom-based assessment and care coordination aligned with the most current clinical guidelines. We are here to help you access the diagnosis and management you deserve without unnecessary delays or barriers.

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Our registered dietitians work with women to develop anti-inflammatory nutritional strategies tailored to endometriosis, supporting both quality of life and long-term reproductive health goals.

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Our therapists provide dedicated mental health support for women living with chronic conditions including the grief, anxiety, and emotional complexity that often accompany a fertility journey with endometriosis.

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The gap in endometriosis care has never been just a research gap. It's a care gap, one defined by fragmented services, long wait times, and providers who treat symptoms in isolation. July Health is built to close that gap: an interdisciplinary team, under one coordinated framework, with expertise in what endometriosis actually looks like in women's lives.

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If you're living with endometriosis and thinking about your fertility, your options, or just where to start, we're here.

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Use our easy online booking to book a free consultation with our July Health team.

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References:

1. Elizur SE, Mostafa J, Berkowitz E, Orvieto R. Endometriosis and infertility: pathophysiology, treatment strategies, and reproductive outcomes. Arch Gynecol Obstet. 2025;312(4):1037-1048. doi:10.1007/s00404-025-08124-1 
2. Grigoriadis G, Roman H, Gkrozou F, Daniilidis A. The Impact of Laparoscopic Surgery on Fertility Outcomes in Patients with Minimal/Mild Endometriosis. Journal of Clinical Medicine. 2024;13(16):4817. doi:10.3390/jcm13164817 
3. T FL, Naveen D, P R, Gopinath P, K GK. Role of endometriosis fertility index system in predicting non-IVF conception in patients with surgically documented endometriosis. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019;8(6):2363-2367. doi:10.18203/2320-1770.ijrcog20192431 
4. Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol. 2022;13. doi:10.3389/fendo.2022.1020827
5. Breintoft K, Pinnerup R, Henriksen TB, et al. Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2021;10(4):667. doi:10.3390/jcm10040667 
6. Qu H, Du Y, Yu Y, Wang M, Han T, Yan L. The effect of endometriosis on IVF/ICSI and perinatal outcome: A systematic review and meta-analysis. Journal of Gynecology Obstetrics and Human Reproduction. 2022;51(9):102446. doi:10.1016/j.jogoh.2022.102446 
7. Diagnosis of Endometriosis: ACOG Clinical Practice Guideline No. 11. Obstetrics & Gynecology. 2026;147(3):432. doi:10.1097/AOG.0000000000006181

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