Periods that are so painful you cannot go to work. Pain during sex. Bloating. Tiredness that does not go away. These symptoms are often dismissed as ‘normal period problems’ — but in many cases, they are signs of endometriosis.
Endometriosis affects approximately 10% of women of reproductive age globally (World Health Organization, 2023). In India, it is widely underdiagnosed because women are taught to tolerate period pain. But when it comes to fertility, endometriosis is one of the conditions that needs to be identified and addressed early.
Dr. Sonu Balhara, IVF & Fertility Expert at ART Fertility Clinics, Gurugram, sees many patients who have been living with undiagnosed endometriosis for years before finally getting answers. The good news — pregnancy is absolutely possible.
What Is Endometriosis?
The inside of the uterus is lined with a tissue called the endometrium. Every month this lining builds up, and if there is no pregnancy, it sheds as a period.
In endometriosis, tissue similar to the endometrium grows outside the uterus — on the ovaries, fallopian tubes, bladder, bowel, or other pelvic structures. This misplaced tissue still responds to monthly hormonal cycles — it builds up and tries to shed — but it has nowhere to go. This causes inflammation, pain, and over time, scar tissue.
How Does Endometriosis Affect Fertility?
- It can damage the fallopian tubes, blocking the path between the egg and sperm
- Endometriomas — cysts filled with old blood — can form on the ovaries and reduce egg reserve
- Inflammation in the pelvic area can affect egg quality and fertilisation
- Scar tissue can distort the uterus and tubes, making conception harder
- The uterine environment may be less receptive to an embryo implanting
The good news: even with endometriosis, many women conceive naturally. And for those who need help, IVF works very well.
Symptoms to Watch For
- Very painful periods — pain that stops you from daily activities
- Pain in the lower abdomen or back during or around periods
- Pain during or after sex
- Heavy or irregular periods
- Pain when going to the toilet during a period
- Bloating — especially around period time
- Difficulty getting pregnant
Many women have endometriosis with very mild symptoms or no symptoms at all. This is why a fertility evaluation is so important even when periods feel manageable.
How Is Endometriosis Diagnosed?
Endometriosis cannot be confirmed by a blood test. The diagnostic options are:
- Ultrasound: Can detect endometriomas (ovarian cysts caused by endometriosis) but cannot see smaller deposits
- MRI: More detailed imaging — can identify deeper endometriosis
- Laparoscopy: The gold standard — a keyhole surgery under anaesthesia where the doctor can see, confirm, and sometimes treat endometriosis during the same procedure
Dr. Sonu Balhara determines which investigation is appropriate for each patient based on symptoms, ultrasound findings, and fertility goals.
Treatment Options for Endometriosis
When trying to conceive naturally
Mild endometriosis with no blocked tubes or large cysts — many women conceive naturally. The focus is on timing and optimising the cycle.
Surgical treatment — Laparoscopy
When endometriosis is causing blockages, distortion, or large endometriomas, surgery can remove or reduce the problem. This can improve natural conception rates and IVF outcomes. However, surgery on endometriomas must be done carefully — it can sometimes reduce ovarian reserve if not performed properly.
IVF
IVF is highly effective for endometriosis-related infertility. It bypasses many of the problems endometriosis causes — blocked tubes, poor egg-sperm meeting — by fertilising the egg in the laboratory. Dr. Sonu Balhara uses specially adapted IVF protocols for endometriosis patients to maximise egg retrieval and embryo quality.
Medical management
Hormonal treatments can suppress endometriosis and manage pain, but they prevent pregnancy while being used. They are not used alongside fertility treatment.
Can You Get Pregnant with Endometriosis?
Yes — and many women do. The likelihood depends on the stage of endometriosis, age, and other fertility factors. Stage 1 and 2 (mild to moderate) endometriosis often allows natural conception with some support. Stage 3 and 4 (severe) may require IVF.
The most important thing is not to wait and see. If you suspect endometriosis and are planning a family, get evaluated now. Earlier treatment gives better outcomes.
Dr. Sonu Balhara | IVF & Fertility Expert | ART Fertility Clinics, Sector 38, Gurugram | Personal Clinic: Sector 46, Greenwood City, Gurugram | +91 9811409586 | sonubalharaivf.com
Conclusion
Endometriosis is not a barrier to pregnancy — it is a condition that needs the right attention at the right time. With proper diagnosis and the right treatment approach, most women with endometriosis can achieve pregnancy.
If you have painful periods, have been trying to conceive without success, or have been told you may have endometriosis — book a consultation with Dr. Sonu Balhara at ART Fertility Clinics, Sector 38, Gurugram.
