Endometriosis and fertility: what you need to know upfront

Endometriosis affects approximately 10% of women of reproductive age — and is one of the leading causes of fertility challenges, accounting for an estimated 30-40% of female infertility cases. If you've been diagnosed with endometriosis and are thinking about your fertility future, egg freezing is worth understanding now, not later.

The reason: endometriosis can progressively damage ovarian tissue, particularly if endometriomas (ovarian cysts filled with old blood) are present. Surgical treatment of endometriomas, while sometimes necessary, also carries a risk of reducing ovarian reserve. This means the window for egg freezing can narrow faster with endometriosis than in women without the condition.

Does endometriosis affect egg quality?

This is a more nuanced question than it appears. Research suggests that endometriosis can affect the ovarian environment in ways that may impact egg quality — inflammation, oxidative stress, and altered follicular fluid all play a role. However, many women with endometriosis produce healthy, viable eggs and have successful pregnancies, naturally or through IVF.

What endometriosis more reliably affects is egg quantity — particularly if endometriomas are present or have been surgically removed previously. Women with endometriosis often have lower AMH and fewer antral follicles than peers of the same age. This makes earlier fertility preservation more strategic.

Egg freezing with endometriosis: what changes in the protocol

The stimulation protocol may need to be adapted — typically with a longer down-regulation phase to suppress endometrial tissue before stimulation begins. Monitoring is closer, as ovarian response can be harder to predict. If you have active endometriomas, your specialist needs to assess whether surgical management is needed before a retrieval cycle, or whether proceeding directly with retrieval is the better approach. This is a case-by-case decision that requires an experienced team.

In Spain, specialists in reproductive endocrinology with deep experience in endometriosis-related infertility are available without the long waiting times of the French public system. This matters particularly when timing is critical.

At WoMA, we work with women with endometriosis regularly. We know that the diagnosis creates urgency, confusion, and often grief. Our role is to help you act at the right time, with the right information — before the window narrows further.

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