Endometriosis and fertility
Endometriosis is tissue like the lining of the uterus growing outside it, on the ovaries, the tubes, the pelvis. It can cause painful periods, pain during intercourse, and difficulty conceiving, and it often goes undiagnosed for years. Dr. Shami treats the pain and the fertility as one story.
How it affects fertility
Endometriosis can distort the anatomy of the pelvis, block or damage the tubes, form cysts in the ovaries (endometriomas) that reduce ovarian reserve, and create inflammation that affects eggs, sperm and implantation. Its effect ranges from none at all to severe, and the severity of pain does not predict the effect on fertility. Some women with severe pain conceive easily; some with no pain have extensive disease.
Who should be assessed
- Women with painful periods that disrupt daily life, pain during intercourse, or pain with bowel movements around the period
- Women who have been trying to conceive without success, especially with those symptoms
- Anyone with an ovarian cyst that looks like an endometrioma on ultrasound
- Women with a family history of endometriosis
- Couples labelled “unexplained” whose workup never considered it
How Dr. Shami diagnoses it
A careful history is the most important test. A detailed transvaginal ultrasound by an experienced eye can identify endometriomas and deep disease. AMH and antral follicle count show what the disease has done to ovarian reserve. Laparoscopy, the only way to prove milder disease, is used when the result would change the plan, not routinely.
How she plans treatment
- 1
Fertility first when time is short
If you want to conceive, hormonal treatments that suppress endometriosis also suppress ovulation, so the plan is built around conceiving, with the pain managed alongside.
- 2
Surgery only when it helps
Removing endometriomas can lower ovarian reserve. Dr. Shami weighs surgery against reserve, age and symptoms, and refers to an experienced surgeon within the clinic group when it is the right call.
- 3
IUI or IVF, chosen by the disease
Mild disease with open tubes may allow ovulation induction with IUI. Significant disease, damaged tubes or low reserve usually mean IVF, sometimes with freezing embryos before any surgery.
- 4
Protection of what remains
Where reserve is at risk, egg or embryo freezing is discussed early, before disease or surgery reduces options further.
Dr. Ghina Shami
Questions patients ask
Can I get pregnant with endometriosis?
Most women with endometriosis do conceive, many without treatment. The disease raises the chance of needing help, and Dr. Shami's role is to work out how much help you need and to avoid steps that could reduce your options.
Should I have surgery before IVF?
Not usually for endometriomas alone, because surgery can reduce ovarian reserve and IVF can proceed with the cyst in place. Surgery is considered for large cysts, severe pain, or when it would make egg collection safer. It is decided case by case.
Does endometriosis affect implantation?
It can, through inflammation and changes in the lining, which is why it is part of Dr. Shami's review of recurrent implantation failure. Preparing the lining carefully before a frozen transfer is one of the ways this is addressed.
Medically reviewed by Dr. Ghina Shami, Consultant Reproductive Endocrinology & Infertility · September 2026
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