Presented today at the 41st Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), the findings offer renewed optimism for millions of women living with endometriosis who are hoping to conceive.
Endometriosis is a long-term condition in which tissue similar to the lining of the womb grows outside the womb, often causing severe pelvic pain and infertility.[2] Globally, it is estimated to affect 190 million women and is recognised as a leading cause of infertility.[3]
This study was conducted as part of the EU FEMaLe (Finding Endometriosis through Machine Learning) consortium. Led by Dr. Lucky Saraswat from the Aberdeen Centre of Women’s Health Research, University of Aberdeen, together with researchers from the Centre for Reproductive Health at the University of Edinburgh, the research team carried out the largest and longest population-based study of its kind, analysing linked primary care, secondary care and maternity records for more than four million women in England who presented with infertility or symptoms related to endometriosis between 1991 and 2020.
Of the 4,041,770 women aged 13-50 years who attended primary care with infertility (n=245,994) or other symptoms of endometriosis, 111,197 had a surgically confirmed diagnosis of endometriosis via laparoscopy or laparotomy over the 30-year period. The overall population prevalence of female infertility across the population during the study period was 48.9 per 1,000 women, with highest rates observed among women aged 30 to 39.
Among those with infertility, 6.1% (14,904) had surgically confirmed endometriosis. Of these, 57.4% (8,556) experienced infertility before their diagnosis, underlining the ongoing delays in recognition and diagnosis of endometriosis.
The study reaffirmed a strong association between the condition and fertility challenges, showing that women with infertility were more than twice as likely to be diagnosed with endometriosis compared to women without infertility.
However, when examining pregnancy outcomes, women with endometriosis-associated infertility had a four times higher chance of conception compared to women with infertility from other causes, including ovulatory dysfunction, tubal factors, and unexplained infertility. In total, 40.5% of women with an endometriosis diagnosis (regardless of their infertility status) had at least one pregnancy during the study period.
Reflecting on the potential explanations for this result, Dr. Saraswat said, “Endometriosis can vary in how it affects fertility. Women with milder forms may retain good reproductive potential, especially if the condition is diagnosed and managed early. There’s also moderate-quality evidence suggesting that laparoscopic surgery can improve pregnancy rates in some with endometriosis.”
She added that women with the condition may also be more likely to seek help earlier because of heightened awareness about the link between endometriosis and infertility.
“While fertility remains multifactorial, with factors such as age playing a significant role, our findings offer robust, evidence-based data that can significantly enhance fertility counselling for women newly diagnosed with endometriosis – including information on the likelihood of infertility, overall pregnancy rates and outcomes, and how those outcomes compare to other causes of infertility.”
“These insights can empower women to make informed reproductive decisions”, she said. “They also provide a strong foundation for future research into how factors such as disease stage, site, surgical treatment and use of assisted reproduction influence pregnancy outcomes in women with endometriosis.”
Professor Dr. Anis Feki, Chair-Elect of ESHRE, commented, “This study shows that women with endometriosis-related infertility are significantly more likely to conceive than those with other infertility causes. These findings provide valuable reassurance for patients and underscore the importance of early diagnosis and tailored treatment strategies.”
The study abstract will be published today in Human Reproduction, one of the world’s leading reproductive medicine journals.
Notes to editors:
A reference to the ESHRE Annual Meeting must be included in all coverage and/or articles associated with this study.
For more information or to arrange an expert interview, please contact the ESHRE Press Office at: press@eshre.eu
About the study author:
Dr. Lucky Saraswat is an endometriosis specialist and honorary senior lecturer at the University of Aberdeen. Her research interests include endometriosis and women’s health conditions with a focus on epidemiological studies using big data, clinical trials, and health services research. She is leading several research studies aimed at optimising treatment of endometriosis, reducing diagnostic delay and exploring experiences and needs of women with endometriosis. She works closely with the Scottish Government Women’s Health Plan team and charities to improve care of those with endometriosis and other women’s health conditions across Scotland.
About the European Society of Human Reproduction and Embryology
The main aim of ESHRE is to promote interest in infertility care and to aim for a holistic understanding of reproductive biology and medicine.
ESHRE collaborates world-wide and advocates universal improvements in scientific research, encourages and evaluates new developments in the field, and fosters harmonisation in clinical practice. It also provides guidance to enhance effectiveness, safety and quality assurance in clinical and laboratory procedures, psychosocial care, and promotes ethical practice. ESHRE also fosters prevention of infertility and related educational programmes and promotes reproductive rights regardless of the individual’s background. ESHRE’s activities include teaching, training, professional accreditations, mentoring and career planning for junior professionals, as well as developing and maintaining data registries. It also facilitates and disseminates research in human reproduction and embryology to the general public, scientists, clinicians, allied personnel, and patient associations.
Website: https://www.eshre.eu/
About Human Reproduction
Human Reproduction is a monthly journal of ESHRE and is one of the top three journals in the world in the field of reproductive biology, obstetrics and gynaecology. It is published by Oxford Journals, a division of Oxford University Press.
References:
[1] Saraswat, L., et al. (2025). Infertility and endometriosis: a 30-yearlong national population-based study of prevalence, association and pregnancy outcomes. Human Reproduction. Supplement Q&A.
[2] Rogers, P. A.W., et al. (2009). Priorities for endometriosis research: recommendations from an international consensus workshop. Reproductive sciences (Thousand Oaks, Calif.), 16(4), 335–346. https://doi.org/10.1177/1933719108330568
[3] World Health Organization. (2023). Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Overview,period%20and%20last%20until%20menopause.
