So You Have Endometriosis—What Does That Actually Mean for Your Fertility?

If you’ve been diagnosed with endometriosis and you’re trying to figure out what that means for your chances of getting pregnant… you’re not alone. The internet can be overwhelming, and honestly, a lot of the advice out there feels either super clinical or way too vague.

The truth is, endometriosis affects everyone a little differently—and when it comes to fertility, there’s no one-size-fits-all answer. But here’s what we do know: around 30% to 50% of women with endometriosis may experience difficulty conceiving. That sounds scary at first, but it doesn’t mean pregnancy is off the table. Not even close.

This article is your judgment-free, research-backed guide to understanding how endo and fertility interact—whether you’re just starting to think about having kids or you’ve been on the trying-to-conceive rollercoaster for a while. We’re breaking down the science, the options, and the real talk—all in one place.

Because no one should have to decode their diagnosis alone.

What Is Endometriosis?

Let’s break this down simply: endometriosis is a condition where tissue similar to the lining of your uterus (called the endometrium) starts growing outside of it. Think ovaries, fallopian tubes, the outer surface of the uterus, and even the intestines. These rogue cells still respond to your monthly hormone cycle—thickening, breaking down, and bleeding—but with nowhere to go, they cause inflammation, scarring, and sometimes intense pain.

According to a 2021 open-access review in Frontiers in Reproductive Health, endometriosis affects around 10% of reproductive-age women worldwide, and many go undiagnosed for years.¹ It’s not just a “bad period”—it’s a whole-body condition that can impact fertility, digestion, immune response, and mental health.

What makes it even more confusing? You can have severe endometriosis and little to no pain, or experience debilitating symptoms with a mild stage diagnosis. And while it can absolutely affect fertility, it doesn’t automatically mean you can’t conceive.

There are four stages of endometriosis—minimal, mild, moderate, and severe—but these stages don’t always predict how hard it will be to get pregnant. That’s why understanding how it affects your body is more important than just knowing your stage.

In short: it’s complex, frustratingly under-researched, but treatable—and you’re not making it up.

How Endometriosis Impacts Fertility

Okay, let’s talk about why endometriosis can make it harder to get pregnant—and what you can actually do about it.

Endometriosis doesn’t just cause pain—it can interfere with fertility in multiple ways. According to a 2020 open-access review in Reproductive Biology and Endocrinology, the main mechanisms include:

  • Inflammation: Endo lesions release inflammatory molecules (like cytokines and prostaglandins), which can negatively affect egg quality, sperm mobility, fertilization, and implantation.¹
  • Scar tissue & adhesions: As endometrial-like tissue grows and breaks down, it can cause scar tissue and adhesions that physically block or distort the reproductive organs—making it harder for eggs to travel down the fallopian tubes.
  • Hormonal disruption: Endometriosis can interfere with estrogen-progesterone balance, which is key for regular ovulation and a receptive uterine lining.
  • Endometriomas (ovarian cysts): These fluid-filled cysts can impair ovarian reserve and egg quality if left untreated.

The good news? You’re not powerless here—and certain treatments can significantly improve your odds of conceiving.

Why Excision Surgery Helps

Laparoscopic excision surgery is currently considered the gold standard for surgically managing endometriosis. Unlike ablation (which burns the surface), excision actually removes the lesions from the root, including deeper ones that may not be visible on scans.

According to a 2023 open-access study in the European Journal of Obstetrics & Gynecology and Reproductive Biology, women with endometriosis who underwent laparoscopic excision saw pregnancy rates as high as 57–70% within 6–12 months after surgery.² The best outcomes were observed within the first six months post-surgery, especially when the fallopian tubes and ovaries were preserved.

The takeaway: if you’re struggling to conceive and suspect endometriosis might be part of the picture, excision surgery could make a major difference. Especially when performed by an endo specialist—not just a general OB-GYN.

Why Inflammation Matters (and How You Can Reduce It)

Let’s get one thing clear: inflammation is not always the enemy. But chronic, unchecked inflammation—like what happens with endo—can interfere with everything from ovulation to implantation.

That’s why anti-inflammatory lifestyle changes can be a game changer when you’re trying to conceive.

Anti-Inflammatory Diet for Endometriosis and Fertility

If you’ve ever googled “endometriosis diet,” you probably ran into a mix of random lists, conflicting advice, and Pinterest meal plans. Let’s cut through the noise.

The goal with an anti-inflammatory diet isn’t perfection—it’s helping your body stay in balance, lower inflammation, and create a more supportive environment for ovulation, implantation, and hormone regulation.

So what exactly is an anti-inflammatory diet?

It’s not about restriction—it’s about supporting your body’s natural hormone detoxification and reducing chronic inflammation (which we know can interfere with conception). A 2019 open-access study published in Nutrients showed that adherence to a Mediterranean-style diet—which is naturally anti-inflammatory—was associated with improved fertility outcomes and reduced endometriosis-related symptoms.¹

What to Focus On:

1. Omega-3-rich foods:

  • Wild salmon, walnuts, flaxseeds, chia seeds
  • These help regulate prostaglandin production (the hormone-like substances involved in inflammation and pain)

2. Leafy greens & cruciferous vegetables:

  • Kale, spinach, broccoli, arugula, cabbage
  • Support estrogen detoxification and are loaded with fiber and antioxidants

3. Healthy fats:

  • Olive oil, avocado, nuts, seeds
  • These fats help regulate hormones and reduce systemic inflammation

4. Colorful berries & anti-inflammatory herbs:

  • Blueberries, strawberries, turmeric, ginger
  • Rich in antioxidants that protect cells and reduce oxidative stress on eggs

5. High-quality protein:

  • Organic chicken, eggs, lentils, chickpeas, tofu
  • Supports hormone production and blood sugar regulation

Foods to Reduce or Avoid (without obsessing):

  • Refined carbs & added sugar: Can spike insulin and drive inflammation
  • Dairy (for some): Some women with endo feel better when they limit dairy, though the research is mixed
  • Processed meats & fried foods: Linked to higher inflammatory markers
  • Alcohol & excess caffeine: Both can worsen estrogen imbalance and oxidative stress

Supplements That Can Actually Support Your Body with Endometriosis

Let’s be real—supplements aren’t magic pills. But when you’re dealing with endo, the right ones can help support your hormones, reduce inflammation, and make your body feel just a little more like it’s on your side.

Here’s a breakdown of supplements worth looking into (and what they’re actually doing behind the scenes).

Magnesium

If you’re dealing with cramps that feel like your uterus is throwing a tantrum—magnesium might be your best friend. It helps relax your muscles, calm your nervous system, and can even support sleep and mood (which, let’s be honest, takes a hit when you’re living with chronic pain).

You can get it from foods like leafy greens, pumpkin seeds, and dark chocolate—but a supplement might help if you’re not getting enough.

DIM (Diindolylmethane)

DIM is a compound that comes from cruciferous veggies like broccoli and Brussels sprouts. It helps your body process estrogen more efficiently—which matters because endometriosis often involves estrogen dominance.

If your body struggles to break down estrogen the way it should, DIM helps reroute things in a gentler, more balanced direction.

Let’s talk bloating—the kind where your jeans don’t fit by noon and you’re not even sure what you ate. Digestive enzymes help your body break down food better, which can ease that inflamed, gassy feeling that’s way too common with endo.

Bonus: better digestion also supports hormone clearance (especially estrogen) through your gut.

Zinc

This little mineral does a lot—immune support, hormone regulation, inflammation control. If you’ve been constantly rundown, dealing with acne, or feeling like your body is fighting itself, zinc may be something to look into.

Foods like oysters, pumpkin seeds, and lentils are great sources—but supplements can help fill the gaps too.

Selenium

Selenium is one of those quiet but powerful minerals. It helps calm inflammation, supports detox pathways, and plays a role in thyroid health—which is often overlooked when talking about fertility and endo.

Just a couple Brazil nuts a day give you enough—but many women with endo still benefit from additional support.

Omega-3s

These are your anti-inflammatory MVPs. Think of them as cooling things down inside your body—reducing prostaglandins (which are linked to pain), supporting egg quality, and making your cycle just a little smoother.

Salmon, chia seeds, flax… yes. But if you’re not eating those often, a good fish oil supplement can do wonders.

NAC (N-Acetyl Cysteine)

NAC is kind of like your body’s cleanup crew. It boosts glutathione (your master antioxidant), helps your liver detox hormones like estrogen, and may even reduce the size of endometriomas over time.

Some women also find it helps regulate cycles and improve ovulation—especially if PCOS is part of the picture too.

Vitamin D

Most of us are low and don’t even realize it. But vitamin D is crucial for immune balance, hormone regulation, and reproductive health. If your levels are low, your inflammation tends to be higher—and your chances of implantation may take a hit.

Get your levels checked if you can, but don’t sleep on this one.

Probiotics (Especially SIBO-Friendly Ones)

Gut health and hormone balance are BFFs. A good probiotic can help reduce bloating, improve digestion, and support estrogen detox via the gut. If you’re sensitive or dealing with SIBO, look for soil-based or spore-forming strains that are easier on the system.

And remember: your gut is one of the main ways your body gets rid of excess estrogen—so if it’s sluggish or inflamed, everything else gets harder.

Not a Cure but A Long Term Management Plan

No supplement is going to “fix” endo on its own. But the right ones—when combined with nutrition, rest, and medical support—can help your body work with you rather than against you. Think of them as part of your team, not the whole game plan.

Stress Reduction That Actually Helps When You’re Dealing with Endo & TTC

Let’s just say it: stress is not the reason you have endometriosis, and no—you’re not going to “relax your way” into getting pregnant. But chronic stress? It really can throw your hormones off, increase inflammation, and make the whole fertility process feel even more overwhelming.

So no guilt here—just options. These are gentle, supportive ways to help your nervous system chill out a bit and give your body space to heal and function at its best.

1. Nervous System Regulation (This Is Bigger Than It Sounds)

When your body is constantly in “fight or flight” mode (hello, pain, medical gaslighting, TTC stress…), it sends signals that it’s not a safe time to prioritize reproduction. Over time, this can mess with ovulation, increase cortisol, and keep inflammation levels high.

What helps:

  • Breathwork: Try box breathing (inhale 4, hold 4, exhale 4, hold 4). It literally signals to your body that it’s okay to relax.
  • Cold therapy: Even just a splash of cold water on your face or a quick cold shower can calm the vagus nerve and shift your nervous system.
  • Grounding techniques: Walking barefoot outside, sipping tea slowly, or placing your hand on your chest to slow your heart rate—simple but powerful.

2. Gentle Movement

Exercise doesn’t have to mean HIIT or running marathons. In fact, if your body is already inflamed or exhausted, pushing too hard might do more harm than good.

Try this instead:

  • Walking: Daily, low-intensity walks help reduce cortisol and support lymphatic flow.
  • Yoga or stretching: Especially poses that target the pelvis and hips.
  • Dancing in your kitchen: Yes, it counts.

3. Creative Outlets (Yes, They Matter)

Painting, journaling, playing music, baking, pottery—whatever lights you up a little or gets you into “flow.” Creativity activates the parasympathetic nervous system (the rest + digest mode), which helps your body shift away from chronic stress patterns.

And no, it doesn’t have to be good. It just has to feel good.

4. Boundaries & Saying No

This one might be the hardest but most healing: cutting out unnecessary energy drains. Whether it’s toxic group chats, unhelpful doctors, or a jam-packed schedule, saying “no” is one of the most underrated ways to reduce stress on your body.

Create space for rest—and protect it like it matters. Because it does.

5. Mindfulness, Meditation, or Just Being Still

We’re not saying you have to sit cross-legged on a mountain. But making time for even 5 minutes of stillness each day—without screens, noise, or to-do lists—can lower inflammation and improve hormone signaling.

Try:

  • Guided meditations (Insight Timer and YouTube have free options)
  • Gratitude journaling
  • Just sitting quietly with your hand on your belly, breathing slowly

Quick Reminder:

Stress is part of life, and you’re not failing if you still feel anxious or frustrated. But finding ways to soften the edges—even a little—can make your fertility journey feel less like a battlefield and more like a process your body and mind can walk through together.

You don’t have to do it all. Just start with one thing that feels doable this week—and build from there.

What to Discuss with Your Doctor About Endometriosis and Fertility

Navigating endometriosis while considering fertility can feel overwhelming. Open, informed discussions with your healthcare provider are key to developing a treatment plan that aligns with your goals. Here are some pivotal questions and considerations to bring up during your appointment:

2. Evaluating Treatment Options

  • What are the available treatment options for managing my endometriosis, especially concerning fertility preservation?Discuss both medical and surgical treatments, weighing their benefits and potential impacts on fertility.​

3. Surgical Interventions: Excision vs. Ablation

  • Can you explain the differences between excision and ablation surgeries for endometriosis? It’s crucial to understand that while both procedures aim to remove endometrial tissue, their effectiveness varies.​
  • Which surgical method do you recommend for my case, and what is your experience with excision surgery? Excision surgery involves the complete removal of endometriotic lesions and is considered the gold standard for treatment. Studies have shown that excision results in lower recurrence rates compared to ablation. For instance, research indicates that laparoscopic excision of endometriomas is associated with a reduced rate of recurrence compared to ablation techniques. ​
  • If you don’t perform excision surgery, can you refer me to a specialist who does? Seeking a surgeon skilled in excision techniques can significantly impact treatment outcomes and reduce the likelihood of recurrence.​

4. Fertility Preservation and Enhancement

  • How might endometriosis affect my ability to conceive, and what steps can we take to optimize my fertility? Discuss fertility assessments and potential interventions to enhance your chances of conception.​
  • Are there lifestyle changes or adjunct therapies you recommend to support fertility alongside endometriosis treatment? Incorporating dietary adjustments, stress management strategies, and appropriate supplements may complement medical treatments.​

5. Post-Surgical Expectations and Follow-Up

  • What should I expect in terms of recovery and symptom relief following surgery? Understanding the recovery process can help you plan and set realistic expectations.​
  • How will we monitor for potential recurrence, and what follow-up care will be necessary? Regular follow-ups are essential to detect and address any signs of recurrence promptly.​

6. Exploring Assisted Reproductive Technologies (ART)

  • If natural conception proves challenging, what ART options should we consider, and how does endometriosis affect their success rates? Understanding the role of treatments like IVF in the context of endometriosis can inform your family planning decisions.​

Empowering Yourself Through Informed Dialogue

Remember, you have the right to seek care that aligns with your health goals and values. If your current provider lacks experience with excision surgery, don’t hesitate to seek a second opinion or request a referral to a specialist. Building a collaborative relationship with a knowledgeable healthcare team can make a significant difference in managing endometriosis and optimizing fertility outcomes.

Doctor Red Flags to Watch For

Let’s be honest—navigating endometriosis is hard enough without being handed outdated, dismissive, or flat-out wrong information. If you hear any of the following from your doctor, it might be time to seek a second opinion or find someone more aligned with evidence-based care:

🚩 “Pregnancy is a cure for endometriosis.”

This one’s still floating around, and it’s just not true. While some women do experience temporary symptom relief during pregnancy, endo is not cured by getting pregnant. The inflammation, lesions, and underlying hormonal imbalances don’t magically disappear—many women have symptoms return postpartum, and some worsen.

🚩 “Lupron (or hormonal suppression) will stop your endometriosis.”

Hormonal suppression can reduce symptoms temporarily—but it doesn’t remove endometriosis. Medications like Lupron can mask pain by shutting down your cycle, but they don’t treat the actual disease, and they often come with serious side effects (like bone density loss, mood swings, and more).

That’s why most endometriosis excision specialists avoid these medications as a long-term solution. Excision surgery is the only approach shown to actually remove the disease at its root.

🚩 “You’re too young to have endometriosis.”

Endometriosis doesn’t care how old you are. It’s been found in teens, women in their twenties, and even in post-menopausal women. If your symptoms match—even if you’re young—you deserve to be taken seriously.

🚩 “Painful periods are normal.”

Nope. Common? Yes. Normal? No. If you’re missing school, work, or social plans because of pain—or relying on heavy medications just to function—it’s time to dig deeper.

You Deserve Better

If you hear any of this, take a deep breath and know this: you are not overreacting, and you are not imagining it. There are incredible doctors out there who understand this disease and can help you move forward with real solutions. And you’re allowed to find one who listens.

You Deserve Support That’s Rooted in Truth—And Built for You

If you’re navigating endometriosis and trying to figure out your fertility, you’ve probably been hit with a mix of confusion, overwhelm, and “wait and see” advice that doesn’t actually help. But you deserve more than that.

You deserve a plan. A place to feel understood. Real answers from people who actually get it.

That’s why we created Plum—and why we built Lina, your personal AI guide. Lina is here to help you map out your next steps: whether it’s building a lifestyle routine that actually supports your body, understanding your nutrition needs, or figuring out what to ask at your next doctor’s appointment.

You can also join our Endo & Fertility community inside Plum, where women share stories, ask questions, and lift each other up without judgment or noise.

Because navigating endometriosis shouldn’t be something you do alone—and now, you don’t have to.

Join us on Plum, meet Lina, and let’s figure this out together.

Citations

Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244–1256. doi:10.1056/NEJMra1810764. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra1810764

Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–598. doi:10.1016/j.fertnstert.2012.05.031. Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-patients/endometriosis_and_infertility.pdf

Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261–275. doi:10.1038/nrendo.2013.255. Available from: https://www.nature.com/articles/nrendo.2013.255

Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362(25):2389–2398. doi:10.1056/NEJMcp1000274. Available from: https://www.nejm.org/doi/full/10.1056/NEJMcp1000274

Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2016(2):CD009591. doi:10.1002/14651858.CD009591.pub2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457840/

Armstrong C. ACOG updates guidance on managing endometriosis. Am Fam Physician. 2011;83(1):84–85. Available from: https://www.aafp.org/pubs/afp/issues/2011/0101/p84.html

Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927–935. doi:10.1016/j.fertnstert.2014.02.012. Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-patients/treatment_of_pelvic_pain_associated_with_endometriosis.pdf

Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752. doi:10.1136/bmj.g1752. Available from: https://www.bmj.com/content/348/bmj.g1752

Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–412. doi:10.1093/humrep/det457. Available from: https://academic.oup.com/humrep/article/29/3/400/2910351

Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–2704. doi:10.1093/humrep/dei135. Available from: https://academic.oup.com/humrep/article/20/10/2698/2356612

Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–598. doi:10.1016/j.fertnstert.2012.05.031. Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-patients/endometriosis_and_infertility.pdf

Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927–935. doi:10.1016/j.fertnstert.2014.02.012. Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-patients/treatment_of_pelvic_pain_associated_with_endometriosis.pdf

Armstrong C. ACOG updates guidance on managing endometriosis. Am Fam Physician. 2011;83(1):84–85. Available from: https://www.aafp.org/pubs/afp/issues/2011/0101/p84.html

Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–412. doi:10.1093/humrep/det457. Available from: https://academic.oup.com/humrep/article/29/3/400/2910351

Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752. doi:10.1136/bmj.g1752. Available from: https://www.bmj.com/content/348/bmj.g1752

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