What a 30-Year Study Reveals About Endometriosis and Fertility

Endometriosis and infertility are two words many women never want to hear – especially together. The pain, uncertainty, and emotional weight can feel overwhelming. And for a long time, the message around endometriosis and Pregnancy has been mostly negative.

But a new, massive study spanning 30 years and involving over 4 million women is flipping that script.

Presented at the 2025 meeting of the European Society of Human Reproduction and Embryology (ESHRE), the findings show that women with infertility linked to endometriosis are more likely to become pregnant than those dealing with other types of infertility.

Yes, you read that right.

Here’s what the study found, what it means, and why it offers new hope for so many women.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it—usually on the ovaries, fallopian tubes, and other pelvic organs. It can cause severe pain, heavy periods, painful sex, fatigue, and infertility.

It’s common—affecting about 190 million women worldwide—and often goes undiagnosed or misdiagnosed for years.

What Makes The Study So Important?

This study stands out for its size, scope, and duration. It’s the largest and longest population-based research project ever conducted on endometriosis and infertility, tracking over 4 million women in England between 1991 and 2020. What makes it especially valuable is how it links primary care visits, hospital data, and Maternity records to give a more complete picture of women’s reproductive health.

Conducted as part of the EU FEMaLe project (Finding Endometriosis through Machine Learning), the study was led by Dr. Lucky Saraswat in collaboration with researchers from the University of Aberdeen and the University of Edinburgh.

Instead of relying on small hospital samples, this research used real-world data to uncover patterns that can now shape how we understand and manage endometriosis-related infertility.

Out of more than 4 million women included in the study, approximately 246,000 were diagnosed with infertility, and over 111,000 had a surgically confirmed diagnosis of endometriosis. Among the women with infertility, 6.1% also had endometriosis confirmed through procedures like laparoscopy or laparotomy. Strikingly, more than half of those women—57.4%—experienced infertility before receiving their endometriosis diagnosis, highlighting the common delays in recognizing the condition.

One of the most surprising findings was the Pregnancy outcome data. Women with infertility linked to endometriosis were found to be four times more likely to become pregnant than women whose infertility stemmed from other causes, such as ovulation problems, tubal damage, or unexplained infertility. This challenges the long-held assumption that endometriosis makes Pregnancy far less likely.

In total, 12.9% of women diagnosed with infertility had at least one Pregnancy during the 30-year study period. Among all women with a confirmed diagnosis of endometriosis—whether or not they were labeled infertile—40.5% had at least one Pregnancy. These numbers reveal that while endometriosis can impact fertility, it doesn’t eliminate the possibility of conception, and in some cases, Pregnancy may be more likely than with other infertility diagnoses.

Why Might Endometriosis Improve Pregnancy Odds?

It seems surprising, but experts have a few possible explanations:

1. Not All Endometriosis Affects Fertility the Same Way

Women with milder forms of the disease may still have good chances of getting pregnant, especially if they’re diagnosed and treated early.

2. Surgery Can Help

Some women with endometriosis undergo laparoscopic surgery to remove endometrial tissue. This can improve their chances of conceiving.

3. These Women May Seek Help Sooner

Because the link between endometriosis and infertility is well known, women with symptoms may be quicker to see a doctor or visit a fertility clinic. That often leads to faster diagnosis and earlier access to treatment like IVF or surgery.

What This Means for You

If you’ve been diagnosed with endometriosis, or think you might have it, here are some key takeaways:

You’re Not Alone

This condition affects millions of women. You’re not imagining your symptoms, and help is available.

Pregnancy Is Possible

A diagnosis of endometriosis doesn’t automatically mean you won’t be able to get pregnant. In fact, your chances may be better than if you had another type of infertility.

Early Diagnosis Helps

If you’re having painful periods, pelvic pain, or struggling to get pregnant, talk to your doctor. The sooner endometriosis is diagnosed, the more treatment options you’ll have.

You Deserve Good Information

This study gives doctors better data to use when talking to patients. It replaces fear with facts and can help guide more thoughtful, personalized treatment.

Dr. Lucky Saraswat, lead researcher, said the study offers hope and better fertility counseling.

“Fertility is influenced by many factors, including age,” she said. “But our findings can help women newly diagnosed with endometriosis understand their chances of getting pregnant and make informed decisions.”

Professor Anis Feki, Chair-Elect of ESHRE, called the findings “valuable reassurance for patients.” He said the results highlight the importance of early diagnosis and tailored treatment plans.

One frustrating part of this study is how many women had infertility before they were diagnosed with endometriosis. That delay can waste time, prolong suffering, and make fertility treatment more difficult.

The takeaway? We still need to do better at recognizing and diagnosing endometriosis early. It shouldn’t take years of pain or failed Pregnancy attempts to get answers.

What’s Next for Research?

While this study gives us a lot of helpful information, there’s still more to learn:

• How does disease stage (mild, moderate, severe) affect Pregnancy odds?
• What are the effects of different types of treatment, like surgery versus IVF?
• Can machine learning tools help spot endometriosis earlier and more accurately?

This study lays the groundwork for answering these questions—and improving care for women in the future.

Endometriosis affects your body, your emotions, your relationships, and your plans for the future.

But this study shows it’s not the end of the road, especially when it comes to Pregnancy.

In fact, women with endometriosis-related infertility had better Pregnancy odds than many might expect. With the right diagnosis, care, and support, there is a path forward.

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