Over 10% of the females in reproductive age suffer from endometriosis, according to the World Health Organization (1). Some of those women will need medical help to conceive and they’re often wondering how successful is IVF with endometriosis? Or even if IVF will work with endometriosis?

50% of the women with mild endometriosis and around 30% of those with moderate to severe endometriosis are able to conceive naturally (2).

However, it’s not straightforward for everyone as endometriosis creates a hostile environment for fertilization and also affects the subsequent implantation of the embryo in your uterus. When left unchecked, it may damage the eggs, block the tubes, form cysts, and change the pelvic environment which can gradually lead to infertility.

How successful is IVF with endometriosis

Do I need to remove endometriosis before IVF?

Your doctor may recommend surgery for endometriosis or IVF right away.

With the right IVF endometriosis protocol, careful monitoring, and the right timing, you have a fair chance of getting pregnant even when you have severe endometriosis. 

What is the best IVF protocol for endometriosis patients?

The following is a general IVF endometriosis protocol which will be customized to your situation:

Treatment for endometriosis first – may be indicated only in certain circumstances or for women who:

  • Have normal AMH (2-6ng/mol) levels in any phase of the cycle
  • Have normal Antral Follicular Count (suggesting normal ovarian reserve)
  • Fallopian tubes are clear
  • Has a partner with a normal sperm count
  • Are between their late 20s and early 30s
  • Haven’t undergone surgery previously
  • Experiencing rapid growth of lesions that are larger than 5 centimeters

IVF procedure directly – may be considered if you have endometriosis along with:

  • Poor ovarian reserve
  • Low AMH levels
  • Reoccurred endometriosis after surgery
  • Damaged fallopian tubes
  • Are older
  • Partner with low sperm count

Can endometriosis stop an embryo from implanting?

Yes, if not planned well, severe or moderate endometriosis may prevent an embryo from implanting.

Can IVF make endometriosis worse?

IVF can worsen endometriosis or the cycle may not be successful if the hormones and fertility parameters are not checked properly.

If excision surgery is performed, the best care should be taken to protect your ovarian reserve. For the best outcome, you must consult with an expert fertility specialist to ensure it is planned well.

What is EFI Score?

The chances of post-operative pregnancy can be determined by calculating the ‘Endometriosis Fertility Index’ or the EFI score (3).

It is calculated by considering factors such as age, years of infertility, prior pregnancy status, etc. The higher the EFI score, the higher the chances of pregnancy postoperatively.

EFI ScoreTreatment
9 -10High chance of conceiving; start with timed intercourse
7 – 9Good chances but may start with IVF
< 7Low pregnancy rate

However, a study of 133 participants found that the duration to natural conception after surgical removal of endometriosis was not much different in women with high or low EFI (4).

What is the success rate of IVF with endometriosis?

Endometriosis IVF success depends upon the stage and severity of the diseases. Your doctor will do a laparoscopic surgical evaluation to determine the location and the stage of the disease you are at.

Stage I and II of Endometriosis

If you are at Stage I or II of endometriosis, you have a higher chance of both natural pregnancy and success with IVF (5). In fact, fertility is rarely impacted in Stage I and II endometriosis and you may be simply recommended medications, hormonal treatments, or intrauterine insemination. Many women even conceive naturally and the pregnancy is known to suppress the symptoms of endometriosis (as speculated to be the case of Queen Victoria).

Stage III and IV of Endometriosis

Infertility is more common in women who are in advanced stages of endometriosis. With stage III or IV, there may be higher cancellation of IVF due to lower oocyte yield, interference of cysts, deeper scarring, and higher gonadotropin requirements (6).

But this doesn’t mean that it is impossible to get pregnant at these stages. IVF is one of the best solutions for Stage III and IV endometriosis.

In an observational study of 96 women who had endometriosis, the IVF success rate with stage III & IV endometriosis was 56.7%, while that with Stage I or II endometriosis was 67.7% (7).

How to get pregnant with endometriosis?

If you’re unable to conceive naturally with endometriosis, you can plan for IVF. The first step in IVF is to stimulate the ovaries for egg production. If endometriomas are present at that time, the response to this stimulation may be poor.

Sometimes, egg quality is poor due to endometriosis and this results in low-quality embryos.

The endometrium in affected patients also has poor receptivity for embryo implantation.

Despite this, people with early treatment for endometriosis were found to have a conception rate of 64.40% through IVF, while untreated women had a success rate of 46.24%, according to a study of 330 participants (5).

Does endometriosis affect your fertility

Once your doctor has diagnosed your endometriosis and determined its severity, you will be recommended surgery, or IVF, or other ART procedures. 

If you’re in advanced age or have poor egg quality because of endometriosis, you can also opt for IVF with donor eggs.

What is the best age to get pregnant with endometriosis?

Women over the age of 35 are more likely to have complications in pregnancy and advanced stage endometriosis may further complicate the matters.

While not everyone can plan for an early pregnancy, if you have the choice, it would be advisable to plan to get pregnant by 35 if you have endometriosis.

Endometriosis surgery

Should you treat endometriosis before trying IVF?

If there are large (lesions larger than 4 cm) and too many endometriomas, they would need to be surgically removed before IVF.

However, the excision of endometrial lesions from the ovaries can also diminish your ovarian reserve. This is especially true if you have bilateral endometriomas. In such cases, you might be recommended to skip the surgery and directly start the IVF treatment.

IVF with Endometriosis success stories

When singer-songwriter Emma Bunton was diagnosed with endometriosis in her early 20s, she was left heartbroken as doctors told her that she would probably never conceive. However, with proper diagnosis and treatment, today Emma is a happy mother of two. 

Pilates instructor Jessica Valant was diagnosed with endometriosis in 2005. In 2012, she was able to conceive her daughter naturally.

However, when she tried for a second baby, her endometriosis was back in full force, which caused her fallopian tubes to be blocked. This is when she decided to go for an IVF.

The first embryos failed to survive and the doctors told Jessica that she had poor egg quality. She was advised to get donor eggs, but she decided to give it another try. A few of her medications were changed to help improve the egg quality.

The IVF was ultimately successful and she gave birth to a healthy baby boy. She shared her inspiring story later on Youtube.

How to improve implantation with endometriosis?

  • Once the IVF process begins, the stimulation injections can cause estrogen to flare up. It is important to carefully monitor the symptoms at every step.
  • Your doctor may prescribe specific drugs that prevent premature ovulation ahead of egg retrieval.

If the endometrial lesions are under control and the quality of eggs is optimal, the chances of a successful embryo implantation are high.

To consult with an experienced fertility specialist and see how successful is IVF with endometriosis, get in touch using the red contact button.
  1. Endometriosis: World Health Organization https://www.who.int/news-room/fact-sheets/detail/endometriosis
  2. Macer, M. L., & Taylor, H. S. (2012). Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and gynecology clinics of North America39(4), 535–549. https://doi.org/10.1016/j.ogc.2012.10.002
  3. Zhou, Yong MD; Lin, Li MB; Chen, Zhengyun MD; Wang, Yuan MB; Chen, Chaolu MB; Li, Enchun MD; Wu, Ruijin MD∗. Fertility performance and the predictive value of the endometriosis fertility index staging system in women with recurrent endometriosis: A retrospective study. Medicine: September 2019 – Volume 98 – Issue 39 – p e16965 doi: 10.1097/MD.0000000000016965
  4. Hobo, R., Nakagawa, K., Usui, C., Sugiyama, R., Ino, N., Motoyama, H., Kuribayashi, Y., Inoue, M., & Sugiyama, R. (2018). The Endometriosis Fertility Index Is Useful for Predicting the Ability to Conceive without Assisted Reproductive Technology Treatment after Laparoscopic Surgery, Regardless of Endometriosis. Gynecologic and obstetric investigation83(5), 493–498. https://doi.org/10.1159/000480454
  5. Zhong, C., Gao, L., Shu, L., Hou, Z., Cai, L., Huang, J., Liu, J., Mao, Y., (2021, July 19). Analysis of IVF/ ICSI in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Birth Rate. State Key Laboratory of Reproductive Medicine, Nanjing, China. Frontiers. https://www.frontiersin.org/articles/10.3389/fendo.2021.640288/full
  6. SonjaPop-Trajkovic, Jasmina Popović Vladimir Antić Dragana Radović Milan Stavanovic Predrag Vukomanović (2014), Stages of endometriosis: Does it affect in vitro fertilization outcome. Taiwanese Journal of Obstetrics and Gynecology. Vol. 53, Issue 2, June 2014, https://doi.org/10.1016/j.tjog.2013.10.040
  7. Paula Kuivasaari, Maritta Hippeläinen, Maarit Anttila, Seppo Heinonen, Effect of Endometriosis on IVF/ICSI Outcome: Stage III/IV endometriosis worsens cumulative pregnancy and live-born rates, Hum Reprod. 2005, Nov; 20 (11) 3130-5, DOI: 10.1093/humrep/dei176

Reviewd by: Dr. Meenakshi, PhD

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