Infertility

Infertility means difficulty getting pregnant after regular, unprotected sex. Clinically, it’s often defined as 12 months of trying if you’re under 35 (or 6 months if you’re 35 or older), but many people seek help sooner when symptoms or known risk factors are present. For some, infertility is the first and only clue that something like endometriosis or adenomyosis may be affecting reproductive function.

With endometriosis, endometrial-like tissue grows outside the uterus—commonly in the pelvis on the ovaries, fallopian tubes, pelvic sidewalls, bladder, bowel, and ligaments. Even when lesions are “small,” the disease can create inflammation, scarring (adhesions), and distorted pelvic anatomy that interferes with egg release, egg pickup by the tube, fertilization, or embryo transport. Endometriosis can also affect egg quality and ovarian reserve, especially when ovarian cysts called endometriomas are present.

With adenomyosis, endometrial tissue grows into the muscular wall of the uterus. This can change how the uterus contracts, increase local inflammation, and alter the uterine environment in ways that may reduce implantation and increase the risk of early pregnancy loss for some patients. Adenomyosis also frequently co-occurs with endometriosis, which can compound fertility challenges.

Infertility has many possible causes—such as ovulation disorders, thyroid disease, male factor infertility, fibroids, tubal blockage from prior infection, or age-related decline—so difficulty conceiving doesn’t automatically mean endometriosis or adenomyosis. What makes endometriosis/adenomyosis distinctive is the combination of pelvic disease biology (inflammation, scarring, immune changes) with symptoms that may include painful periods, pelvic pain, bowel/bladder symptoms, or pain with sex—though symptoms can be minimal or absent.

Beyond the medical definitions, infertility can affect every part of life: relationships, intimacy, mental health, finances, and your sense of control over your body. If you suspect endometriosis or adenomyosis, a specialist-focused evaluation (not “wait and see”) can clarify what’s driving the problem and what options best fit your goals. You can learn more about how we approach this at Evaluation & Diagnosis.

Infertility often doesn’t “feel” like a physical symptom at first—it can feel like time passing: month after month of negative pregnancy tests, hope followed by disappointment, and the sense that your body isn’t doing what it’s supposed to. Many patients describe it as a quiet but persistent stressor that affects mood, sleep, concentration, and relationships.

When infertility is linked to endometriosis or adenomyosis, it may be accompanied by pelvic symptoms such as painful periods, pelvic pain, deep pain during intercourse, bowel or bladder discomfort, or fatigue—but not always. Some people are surprised to learn they have endometriosis because their periods are “normal enough,” yet conception remains difficult.

Experiences can vary widely. One person may have severe pelvic pain and still conceive quickly, while another with minimal pain may struggle for years. Some notice the difficulty becomes more apparent with age, after stopping birth control, after a miscarriage, or after surgery for ovarian cysts.

For others, the cycle itself becomes a monthly reminder: worsening pelvic pain around ovulation or the period, spotting, or heavy bleeding can intensify the emotional impact. It’s valid to feel grief, anger, numbness, or isolation—especially if you’ve been told your tests are “fine” without deeper investigation.

Endometriosis affects approximately 10% of women of reproductive age, and infertility is one of its most well-recognized complications. Estimates vary by study and population, but endometriosis is found in a substantial portion of people evaluated for infertility—often cited around 25–50% in infertility populations. Importantly, infertility may be the first clue because endometriosis can be present for years before diagnosis (often 7–10 years).

Adenomyosis has historically been underdiagnosed, especially in younger patients, but improved imaging has shown it can affect people during reproductive years and may be associated with reduced fertility and lower implantation rates—particularly in IVF settings. Adenomyosis also frequently overlaps with endometriosis, which can make it hard to separate which condition is contributing most.

Infertility risk does not always correlate neatly with visible disease severity. Some patients with minimal disease have significant fertility challenges (likely driven by inflammation/immune effects), while others with advanced disease conceive. Location matters: ovarian endometriomas, deep disease around the tubes/ovaries, and pelvic adhesions are more likely to interfere with conception mechanics.

In endometriosis, infertility can result from multiple overlapping mechanisms. Chronic pelvic inflammation may impair egg quality, sperm function, and fertilization, and it can also disrupt the delicate environment needed for embryo development. Adhesions can “tether” ovaries and tubes, altering normal anatomy so the tube can’t easily pick up the egg after ovulation.

Endometriosis can also affect the ovaries directly. Endometriomas and prior ovarian surgery may reduce ovarian reserve in some patients, and inflammation around the ovary may affect follicle development. Deep infiltrating disease can involve structures near the uterus and tubes, contributing to pain and potentially altering function.

In adenomyosis, the uterine muscle and lining environment may be less favorable for implantation. Proposed contributors include increased local inflammation, altered uterine peristalsis (contractile patterns that can affect sperm/embryo transport), and changes in the junctional zone where implantation-related signaling occurs. Some patients also experience heavy bleeding and anemia, which can add fatigue and stress during fertility attempts.

Both conditions can also contribute to pelvic nerve sensitization and stress physiology, which doesn’t “cause” infertility in a simple way but can worsen pain, reduce sexual comfort and timing, and increase overall strain. Coexisting conditions—fibroids, PCOS, thyroid disorders, male factor infertility—can further affect outcomes, which is why a comprehensive workup matters (see Related Conditions).

Treatment depends on your age, timeline, symptoms, prior history, and whether the goal is spontaneous conception, fertility preservation, or assisted reproduction. A thorough evaluation often includes ovulation assessment, semen analysis, imaging of uterus/ovaries, and assessment of tubal patency—alongside a targeted endometriosis/adenomyosis evaluation (learn what to expect at Evaluation & Diagnosis).

Medical therapy can be used strategically, especially when adenomyosis or endometriosis inflammation is suspected. Options may include hormonal suppression (such as progestins or other therapies) to reduce inflammatory activity; however, suppressive hormones generally prevent pregnancy while you’re taking them, so timing and sequencing matter. For symptom relief alongside fertility planning, evidence-based options may include targeted pain strategies (see Pain Management) and selected hormonal approaches (see Hormonal Therapy).

Surgery can be a key option for appropriate candidates—especially when endometriosis is suspected to be distorting pelvic anatomy, causing endometriomas, or contributing to significant pain. In expert hands, excision surgery (removal of disease at the root) is considered the gold standard and may improve pain and, in some cases, fertility outcomes. Learn more about our approach to advanced minimally invasive care at Surgery & Advanced Excision and about surgeon expertise and complex-case management with Dr. Steven Vasilev.

For adenomyosis-related fertility issues, treatment may include hormone-based strategies to calm disease activity before trying to conceive, optimizing iron stores if bleeding is heavy, and coordinating care with reproductive endocrinology when indicated. Some patients pursue IVF/ART sooner based on age, ovarian reserve, or duration of infertility—especially if tubes are affected or time is critical.

Supportive care matters, too. Pelvic floor physical therapy can help if pain with intercourse is limiting timing, and integrative approaches (sleep, anti-inflammatory nutrition, stress regulation, targeted supplements when appropriate) can support overall health while you pursue definitive treatment; see Integrative Medicine & Lifestyle Care. For a personalized plan that balances symptom relief with fertility goals, we encourage you to contact us.

Seek urgent care right away if you have severe one-sided pelvic pain, fainting, shoulder pain with dizziness, heavy bleeding soaking pads hourly, fever, or suspected pregnancy with pain/bleeding—these can signal emergencies such as ectopic pregnancy or ovarian torsion.

Schedule a specialist visit if you’re under 35 and have been trying for 12 months, if you’re 35+ and trying for 6 months, or sooner if you have symptoms suggestive of endometriosis/adenomyosis (painful periods, pelvic pain, pain with sex, heavy bleeding) or a history of endometriomas, pelvic surgery, or miscarriages. Early intervention matters because endometriosis often takes years to diagnose, and fertility planning is time-sensitive.

When you meet with a clinician, bring a concise timeline: how long you’ve been trying, cycle length/ovulation tracking, pregnancy history, pain and bleeding patterns, prior imaging/surgeries, and any family history. If you’re not getting clear answers—or you’re told it’s “normal” without a plan—it’s reasonable to advocate for specialty evaluation. If you’re ready for expert guidance, you can schedule a consultation.