How Deep Endometriosis Affects a Woman’s Ability to Conceive
                     How Deep Endometriosis 
Affects Fertility
Deep endometriosis (DE) is the most aggressive form where 
lesions infiltrate ≥5mm below the peritoneum, commonly involving 
uterosacral ligaments, rectovaginal septum, bowel, bladder and 
ureters. It affects fertility through anatomical, inflammatory and 
endocrine pathways—but timely, individualized care makes 
pregnancy possible.
Four Ways Deep Endometriosis Reduces Fertility
Distorted Pelvic Anatomy Inflammatory Disruption
Deep nodules and adhesions tether ovaries and Peritoneal inflammation, oxidative stress, and 
fallopian tubes, blocking fimbrial pickup and creating altered cytokines reduce ovulation, fertilization, 
mechanical barriers to natural conception. embryo quality, and endometrial receptivity.
Reduced Ovarian Reserve Co-existent Disease
Endometriomas and repeated ovarian surgery impair Adenomyosis and superficial lesions often coexist 
AMH levels and oocyte yield in IVF cycles. with DE, further compromising implantation and 
pregnancy rates.
Diagnosis: Imaging First
Laparoscopy is no longer the gold standard. Expert transvaginal 
ultrasound (TVUS) and/or MRI can characterize and localize deep 
disease without delaying treatment.
Diagnostic Performance
• TVUS sensitivity/specificity: ~0.79/0.94
• MRI sensitivity/specificity: ~0.94/0.77
Dr. Mona Saad uses targeted TVUS ± MRI first to individualize 
fertility plans based on accurate imaging.
Does Endometriosis Cause 
Infertility?
Yes—but it's not absolute
Deep endometriosis is associated with reduced natural fecundity 
through multiple mechanisms. However, many women conceive 
spontaneously or with IUI or IVF when treatment is informed by 
modern imaging, careful surgical planning, and thoughtful use of 
assisted reproductive technology.
Fertility Treatment Pathways
Expectant/Timed Intercourse
Reasonable if pain is manageable, anatomy normal, ovarian reserve sufficient, and Endometriosis 
Fertility Index (EFI) predicts good spontaneous rates.
IUI with Mild Stimulation
For minimal-mild disease with patent tubes. Shortens time to pregnancy but not typical for severe DE anatomy.
IVF/ICSI
Best for DE, reduced EFI, age >35, low AMH, or male factor. Bypasses pelvic distortion—usually fastest 
path to pregnancy with comparable live-birth rates.
IVF Success Rates with Endometriosis
94% 79%
Comparable Outcomes Diagnostic Accuracy
Live-birth rates similar to other indications when TVUS sensitivity for detecting deep endometriosis
controlling for age and reserve
Extended GnRH-agonist suppression is no longer routinely recommended. Antagonist-based IVF with individualized 
stimulation is the current standard, delivering excellent results.
When to Consider Surgery
Pain first, not fertility first. Surgery addresses pain relief, obstruction, or follicle access—not just IVF outcomes.
Endometriomas Bowel/Urinary Tract Disease
Routine cystectomy not recommended before IVF Requires multidisciplinary planning with colorectal 
unless cyst is suspicious, painful, infected, or or urology specialists to minimize complications 
obstructs retrieval. Consider freezing and protect fertility. Nerve-sparing laparoscopic 
oocytes/embryos before any ovarian surgery due to excision is performed by Dr. Mona Saad's expert 
AMH drop risk. team.
Your Path Forward with Dr. Mona Saad
Comprehensive Care Includes:
• One-visit diagnostic workup with targeted TVUS and reserve testing
• Multidisciplinary surgical planning for deep disease
• IVF with endometriosis-aware protocols
• Fertility preservation options
Deep endometriosis affects fertility—but doesn't exclude pregnancy. With proper imaging, careful surgery, 
and focused ART, most women achieve pregnancy on timelines comparable to other infertility diagnoses.
Ready to start your fertility journey? Dr. Mona Saad, the best female gynecologist in Dubai & Sharjah, 
provides personalized fertility planning from natural conception to IVF—ensuring timely, effective, and safe 
treatment for every woman with endometriosis.
Address Phone No. Website
Medcare Hospital - King Faisal St - +971 50 510 4889 https://www.drmonasaad.com/
Bu Shaghara - Hay Al Qasimiah - 
Sharjah