Endometriosis and infertility treatment

Discuss the following options with women, and trans men, and non-binary people with female reproductive organs who have endometriosis:

• expectant management for up to 2 years (including the time already spent trying to conceive before assessment)
• surgical treatment of endometriosis
  • excision or ablation of endometriosis plus adhesiolysis should be offered for endometriosis not involving the bowel, bladder or ureter, because this improves the chance of spontaneous pregnancy
  • laparoscopic ovarian cystectomy with excision of the cyst wall, or laparoscopic drainage and ablation - should be offered to women or people with endometriomas, because this improves the chance of spontaneous pregnancy. Take into account:
    • the possible impact on ovarian reserve
    • that ablation and drainage may preserve ovarian reserve more than cystectomy

• discuss the benefits and risks of laparoscopic surgery as a treatment option with women or people who have deep endometriosis (including endometriosis that involves the bowel, bladder or ureter) and who are trying to conceive so they can make an informed decision on its use. Topics to discuss may include:
  • possible impact of deep endometriosis on pregnancy outcomes
  • whether laparoscopic surgery may alter the chance of future pregnancy
  • possible impact on fertility if complications arise
  • alternatives to surgery
  • other fertility factors

• do not offer hormonal treatment alone or in combination with surgery to women or people with endometriosis who are trying to conceive, because it does not improve spontaneous pregnancy rates

If the woman, trans man or non-binary person with endometriosis has not conceived during 2 years of expectant management or after surgical treatment, or if expectant management or surgical treatment (or both) is not appropriate, discuss the fertility treatment options and:

• consider up to 4 cycles of intrauterine insemination (IUI) with ovarian stimulation using gonadotrophins before offering IVF treatment, if appropriate, or
• offer IVF treatment

Reference:

1. NICE. Endometriosis: diagnosis and management. NICE guideline NG73. Published September 2017, last updated March 2026.