Fertility and Endometriosis: Community Q&A

We’ve received many calls and messages from our community seeking clear, simple answers about fertility, IVF, and endometriosis, topics that can often feel overwhelming and confusing. To help cut through the noise, we’ve put together this Community Q&A filled with practical, easy-to-understand information. Whether you’re just beginning to explore your fertility options or are already on your IVF journey, we hope this guide helps you feel informed, supported, and a little less alone.

This resource has been collated by Ash, our Community & Organisational Support Officer, fellow endo warrior, and IVF veteran, who understands firsthand how important it is to have accessible and compassionate information at every step of the journey.

Disclaimer: The information below is provided for general education and awareness only. It is not intended as medical advice. Every individual’s situation is unique, and we encourage you to seek guidance from your fertility specialist or healthcare professional regarding your personal circumstances.

Does excision surgery for stage 4 endometriosis improve fertility outcomes?

Excision surgery for advanced (stage 4) endometriosis can sometimes improve the likelihood of natural conception, particularly if the fallopian tubes remain open and no other fertility factors are present. Outcomes are also influenced by age, ovarian reserve, and overall health. Some individuals may attempt natural conception after surgery before considering assisted reproductive options such as IVF. It is best to discuss timing and next steps with your fertility specialist.

What is the difference between egg and embryo freezing, and which is more effective?

Both egg and embryo freezing are established methods of fertility preservation. The most suitable approach depends on age, ovarian reserve, relationship status, and whether donor sperm is being used.

• Egg freezing preserves flexibility for future use.

• Embryo freezing may provide more certainty about outcomes, as fertilisation and early development are confirmed in advance.

For embryo transfers, both natural and medicated (hormone replacement) protocols are used. In individuals with conditions such as PCOS or endometriosis, the choice of protocol is individualised to optimise success.

How does a low AMH level affect IVF planning?

A lower AMH (anti-Müllerian hormone) level, such as 1.6 pmol/L, suggests a smaller number of eggs may be collected per cycle. Some specialists recommend creating embryos sooner in this situation, as this may improve the likelihood of successful use in future. Importantly, many people with low AMH still achieve pregnancy with IVF. The optimal pathway will depend on personal goals, partner fertility, and clinical advice.

What effect does adenomyosis have on implantation?

Moderate-to-severe adenomyosis may reduce implantation rates in some cases. Pre-treatment strategies prior to IVF or frozen embryo transfer (FET) may help improve outcomes, though this is highly individualised. Fertility specialists will tailor treatment to each person’s clinical profile.

Why might embryo numbers be low in IVF, even with male factor infertility?

Even when sperm and eggs are of good quality, not all fertilised eggs develop into viable embryos. For example, if 10 eggs are collected and 8 fertilise, only a proportion may progress to transferable or freezable embryos. This reflects natural biological variation. Egg quality, sperm quality, and laboratory conditions all contribute. Your specialist can review stimulation or laboratory strategies to support the best possible outcomes.

Can IVF make endometriosis or adenomyosis worse?

There is no strong evidence that IVF accelerates the progression of endometriosis or adenomyosis. Symptoms may fluctuate during treatment cycles due to hormone exposure, but IVF is routinely and successfully used by people with these conditions. Risks and benefits should always be reviewed with your healthcare team.

Is it necessary to pursue egg or embryo freezing immediately after excision surgery?

Fertility preservation can be undertaken either soon after excision surgery or following recovery, with generally similar outcomes. Timing should be guided by both the surgeon and fertility specialist to ensure the best balance between recovery and reproductive goals.

Should embryos be tested before transfer?

Preimplantation genetic testing for aneuploidy (PGT-A) is an option, but it is not recommended for everyone. While the test provides genetic information, it does not always predict the true potential of an embryo, and in some cases may reduce the chance of using viable embryos. Whether to proceed with testing should be carefully considered with your fertility specialist, based on age, medical history, and personal priorities.

Is an AMH of 6 considered low?

Yes, an AMH level of 6 pmol/L is typically considered in the lower range. This indicates fewer eggs may be retrieved during stimulation, but many individuals with low AMH still achieve pregnancy. AMH is only one measure of fertility potential and must be interpreted alongside age, cycle history, and ultrasound findings.

What are the chances of pregnancy with PCOS, adenomyosis, and stage 4 endometriosis?

Although these conditions add complexity, many individuals do achieve pregnancy. PCOS often comes with a higher egg reserve, which may be advantageous in IVF. Endometriosis and adenomyosis may require additional planning, but with tailored treatment strategies, pregnancy remains possible.

Is there an increased risk of OHSS in people with PCOS and high AMH?

Yes, people with PCOS and higher AMH levels may be at increased risk of ovarian hyperstimulation syndrome (OHSS). However, modern IVF protocols have significantly reduced this risk through careful dose adjustments, alternative trigger medications, and close monitoring.

Is down-regulation recommended for frozen embryo transfer in adenomyosis?

Down-regulation protocols are sometimes used to improve implantation rates in people with adenomyosis. However, this is not universally required, and other approaches may also be suitable. Treatment protocols should be tailored to the individual’s history and clinical presentation.

Key Takeaway

Endometriosis, PCOS, and adenomyosis can all influence fertility, but with personalised care, many individuals achieve successful pregnancies. Every pathway is unique, seeking advice from a fertility specialist is essential to making informed choices about treatment and timing.