Endometriosis & Fertility

What Is Endometriosis?

Endometriosis is one of the most common yet often overlooked causes of infertility, significantly affecting a woman’s ability to conceive naturally. If you are experiencing symptoms or have been diagnosed and are seeking solutions for endometriosis and fertility, there are now specialized methods and treatments that can improve your chances of conception—even in advanced stages of the condition.

Endometriosis is a chronic, inflammatory gynecological condition characterized by the presence of endometrial tissue – that is, tissue similar to the one that normally lines the inside of the uterus – in areas outside the uterus, such as the ovaries, fallopian tubes, peritoneum, and even the intestines or bladder. This ectopic tissue is affected by hormonal changes of the menstrual cycle and reacts like endometrial tissue: it thickens, bleeds, and causes inflammation, creating adhesions, cysts, and scarring in nearby tissues.

The disease can be present even without pronounced symptoms, making diagnosis difficult and often delayed. However, many women experience severe pelvic pain, especially during menstruation, pain during intercourse, menstrual irregularities, gastrointestinal symptoms, or fertility problems.

Endometriosis is not just a “bothersome” condition; it can have a profound impact on a woman’s physical and psychological health, especially when associated with conception difficulties. It is estimated that approximately 30% to 50% of women with endometriosis have difficulty achieving pregnancy. Early diagnosis and correctly personalized treatment can significantly improve both quality of life and the chances of pregnancy,

Symptoms & Diagnosis

Endometriosis may manifest in different ways depending on its severity and location. In some cases, it is entirely asymptomatic, while in others it causes intense pain and affects a woman's daily life and fertility. Recognizing the symptoms and obtaining the correct diagnosis is crucial for choosing the appropriate treatment approach.

Main Symptoms

Severe menstrual pain (dysmenorrhea)

Pain during sexual intercourse (dyspareunia)

Chronic pelvic pain

Irregular menstrual cycles or bleeding between periods

Constipation or diarrhea, especially around menstruation

Discomfort during urination or bowel movements

Fatigue and a general sense of discomfort

Difficulty conceiving or infertility

Symptoms are often misinterpreted or considered normal, leading to delayed diagnosis, which may exceed even 7 years from symptom onset.

Examinations (Ultrasound, Laparoscopy)

Diagnosis of endometriosis is based on a combination of medical history, clinical examination, and specialized imaging techniques:

Transvaginal Ultrasound (TVUS)

Helps identify endometriotic cysts in the ovaries (endometriomas) but has limitations in visualizing lesions in other areas.

Magnetic Resonance Imaging (MRI)

Useful for detecting deep infiltrating endometriosis, especially in the intestines or bladder.

Laparoscopy (diagnostic):

The gold standard in diagnosis, allowing direct visualization and biopsy of lesions. The procedure is performed under general anesthesia and has both diagnostic and therapeutic value. Early recognition of symptoms combined with specialized diagnostic testing leads to timely intervention, reducing the impact of endometriosis on fertility and a woman’s quality of life.

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How Does It Affect Fertility?

Endometriosis affects fertility through various mechanisms that alter the anatomy of the pelvis as well as the function of the ovaries, fallopian tubes, and endometrium. Even in mild forms, the condition can reduce natural conception chances, making medical intervention necessary.

Decreased Conception Rate (15% vs 30%)

According to scientific data, women with endometriosis have about a 15% chance of conceiving naturally, compared to 30% in women without the condition, within one year of regular intercourse. This rate is influenced by the degree of endometriosis, the woman’s age, and other factors such as the presence of adhesions or ovarian cysts. In advanced stages, anatomical distortion of the pelvis and dysfunction in the fallopian tubes hinder natural fertilization.

Microscopic view of IVF cell structures relevant to endometriosis fertility treatment options for couples seeking conception support.

Egg Quality & Inflammation

The chronic inflammation caused by endometriosis creates a toxic microenvironment around the ovaries, directly affecting egg quality and ovarian tissue function. Inflammatory factors such as prostaglandins and cytokines alter folliculogenesis physiology and reduce the egg’s ability to be fertilized. Moreover, endometriosis can also affect endometrial receptivity, lowering the chances of successful embryo implantation. Assisted reproductive techniques, such as IVF, offer meaningful solutions, especially when accompanied by proper preparation and individualized management.

Fetal development inside womb highlighted by warm glow, illustrating IVF conception success after endometriosis fertility treatments.

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Modern Treatments for Endometriosis

Management of endometriosis depends on age, stage of the disease, symptom severity, and—above all—the desire for childbearing. Modern treatments for endometriosis combine pharmaceutical options, minimally invasive surgical methods, and, when required, assisted reproductive techniques such as in vitro fertilization (IVF). The goal is symptom relief, preservation of fertility, and restoration of quality of life.

Medications

Surgical Removal (Laparoscopy / Robotic)

Medical treatment aims mainly at suppressing ovulation and hormonal effects that worsen endometriosis symptoms. The most common options are listed below:

  
        Category
        Advantages
        Disadvantages
      
        Birth control pills (combined or progestin-only)
        Regulate cycle, reduce symptoms
        Do not cure disease, side effects
      
        Progestins (Dienogest, Medroxyprogesterone)
        Suppress endometriotic activity
        May cause bleeding and weight fluctuations
      
        GnRH analogues (agonists/antagonists)
        Strong suppression of lesions
        Menopausal side effects, limited duration
      
        NSAIDs
        Pain relief
        Do not affect disease progression

Category	Advantages	Disadvantages
Birth control pills (combined or progestin-only)	Regulate cycle, reduce symptoms	Do not cure disease, side effects
Progestins (Dienogest, Medroxyprogesterone)	Suppress endometriotic activity	May cause bleeding and weight fluctuations
GnRH analogues (agonists/antagonists)	Strong suppression of lesions	Menopausal side effects, limited duration
NSAIDs	Pain relief	Do not affect disease progression

Joyful couple celebrating positive pregnancy test after IVF treatment for endometriosis-related fertility challenges and success.

Surgical treatment of endometriosis involves removal or cauterization of endometriotic lesions using laparoscopy or robot-assisted laparoscopy. This procedure has both diagnostic and therapeutic value and significantly improves natural conception rates, especially in women with mild to moderate endometriosis.

The main advantages of the minimally invasive approach include:

Precise mapping and removal of endometriotic lesions

Preservation of fertility and ovarian function

Significant reduction of pelvic pain

Fast recovery and minimal incision

Robotic surgery offers even greater precision and minimizes trauma to healthy tissues, which is particularly important in women trying to conceive. In many cases, surgical treatment is combined with medication or precedes IVF to increase fertilization success rates. Choosing the right treatment is individualized and based on collaboration with a specialized medical team.

IVF & Other Assisted Reproductive Techniques

Endometriosis can make natural conception difficult or even impossible, especially when it affects the fallopian tubes, ovaries, or endometrial receptivity. Modern assisted reproductive techniques, with IVF as the main method, offer meaningful solutions for couples struggling with endometriosis-related infertility. Through careful medical evaluation and personalized treatment protocols, conception chances can increase significantly.

When to Choose IVF

IVF is usually recommended in the following cases:

When endometriosis is severe (stage III–IV) and extensive adhesions or cysts have formed

When medical or surgical treatment has not led to pregnancy

When a coexisting infertility factor is present (e.g., low sperm count/motility)

When the woman is over 35 and has low ovarian reserve

When waiting time for natural conception exceeds 6–12 months without success

IVF bypasses certain barriers created by endometriosis, such as disrupted fallopian tube function or reduced egg motility.

Mitochondrial Replacement Therapy (MRT) – Clinical Trials in Greece

Mitochondrial replacement therapy (MRT) is an innovative technique used in selected cases of women with severe egg dysfunction, often due to endometriosis or age-related decline. This method combines the mother’s genetic material with healthy donor mitochondria, improving egg energy output and increasing chances of successful fertilization and implantation. In Greece, controlled MRT clinical trials have already begun in selected assisted reproduction centers, with encouraging initial results. This technique is not indicated for all cases, but it opens new possibilities for women with infertility resistant to conventional IVF. These developments highlight the importance of access to specialized clinics and scientific teams that implement the most advanced reproductive protocols with the goal of personalized success.

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Endometriosis & Fertility

How long does it take to diagnose endometriosis?

Diagnosis of endometriosis can be delayed 5 to 10 years, as symptoms are often misinterpreted or attributed to other conditions such as irritable bowel syndrome or painful periods.

Can there be endometriosis without pain or symptoms?

Yes, many women have endometriosis without any apparent symptoms. Infertility may be the only symptom that leads to diagnosis.

How does endometriosis affect the fallopian tubes?

Endometriosis can cause adhesions around the fallopian tubes, restricting their movement and obstructing natural fertilization.

Can I conceive naturally with mild endometriosis?

Yes, many women with mild endometriosis conceive naturally, especially if there are no other infertility factors and if the tubes remain functional.

How much does age affect IVF success with endometriosis?

Age is a decisive factor. Women under 35 have significantly higher success rates, even with endometriosis, compared to older women.

Can diet affect endometriosis symptoms?

Yes, anti-inflammatory dietary approaches (e.g., reduced processed foods, sugar, and red meat) may help reduce symptoms.

Is there a risk of recurrence after surgery?

There is a possibility of recurrence, especially if no appropriate hormonal or supportive treatment follows surgery. Choosing the right protocol significantly reduces this risk.

Can egg freezing be done in women with endometriosis?

Yes, egg freezing is particularly recommended for women with endometriosis, as the condition may negatively impact ovarian reserve over time.

Does endometriosis affect the course of pregnancy?

In most cases, once pregnancy is achieved, symptoms of endometriosis subside. However, in some cases there may be an increased risk of miscarriage or complications depending on disease severity.

What alternative treatments are used for endometriosis?

Some women try complementary approaches like acupuncture, pelvic floor physiotherapy, or psychotherapy for chronic pain management. These do not replace medical treatment but can serve as supportive options.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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FertulityThrough the Words of our Parents

100% genuine, public Google reviews.
Because every fertility journey begins with honesty and trust.

      EXCELLENT  
   Based on 12 reviews 
    
 
 
 
   
 
 
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   Μαρια 
 26 days ago
 
 
  The word "thank you" to Dr. Makis Papadopoulos is too small to describe the gratitude we feel for this man. I am pregnant after IVF, having succeeded on the first attempt, and we owe this exclusively to our doctor. First Contact & Communication: From the very first contact, he won us over with his kindness, enthusiasm and willingness to dedicate as much time as we needed. Willing to explain everything in every detail, he solved every question we had in depth — not even a professor to students would analyze them with such patience and contagiousness! Scientific Training: He is an excellent scientist, with deep knowledge of the subject, a perfectionist and focused professional who leaves absolutely nothing to chance. He designed the right treatment for us, solving every problem down to the last detail, making us feel that whatever problem arises, it is certain that it will be solved. HUMANITY & SUPPORT: The most important thing, however, is his humanity. Communication with him was Immediate and he always had as much time as you needed on the phone to solve every question. He showed a deep, real interest, embracing us not just as a doctor, but as if he were our brother. We highly recommend him to every couple starting this journey. He deserves blind trust! We thank you from the bottom of our hearts for the greatest miracle of our lives!

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   Alexandra 
 52 days ago
 
 
  I don't often write reviews, but I feel that Mr. Makis truly deserves it. From the very first moment, he made me feel safe and confident. He listened carefully to what was on my mind, answered every question I had, and explained everything in a simple way, always based on scientific data. Many times, he even sent me relevant scientific studies so that I could better understand why he was suggesting a particular approach. But what stood out to me the most was that he didn't stop at the appointment. He followed up, was genuinely interested in my progress, and was available when I needed him. This is something you rarely encounter. Fortunately, he returned to Greece. He is one of the few doctors who, beyond their knowledge, remain above all human beings. He makes you feel like he sees you as a person and not as just another incident.

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   Matina 
 69 days ago
 
 
  A big thank you to Dr. Makis Papadopoulos who supported us from day one, who checked every little detail, who explained to us every move-step, every test, every medication for the reason we were doing it and what we would achieve. With incredible experience, knowledge, a lot of patience (because we had two other failed attempts with another doctor) and trust, within 8 months he adapted the protocols for our case and we achieved the positive result and we hold in our arms a priceless diamond. Above all, a rare person, calm and always available to listen to our concerns and reassure us. I highly recommend him!

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   Eva 
 93 days ago
 
 
  Thanks to Dr Makis Papadopoulos, I am now holding my two beautiful babies in my arms! He is a true expert. Professional with a human centric approach, friendly and empathetic, always available to answer our (many many) questions. I trust Dr Makis blindly and, honestly, I cannot recommend him enough!
  
 
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   Ivy 
 100 days ago
 
 
  My experience with Dr. Makis took me from a clinical stagnation to an incredible breakthrough, highly recommend Dr. Makis! Navigating the exhausting world of IVF, you know how devastating it is to watch your protocol dosages go up while your results go down. After three intense, high-dosage cycles with a previous clinic, I was left feeling incredibly discouraged. Despite escalating medications and growth hormones, my blastocyst yield was dwindling, culminating in a heartbreaking round with zero blastocysts. I knew I needed a doctor who didn't just follow a standard script, but who truly understood the nuances of egg quality and customized protocols. That is when I found Dr. Makis. Dr. Makis completely revolutionized my treatment plan. Instead of just pushing maximum dosages, he took a highly strategic, tailored approach. The result? Quality over pure protocol size. While my previous doctors kept increasing the medication dosages (which yielded fewer or zero blastocysts), Dr. Makis completely changed the strategy. He lowered the heavy stimulation, introduced smart egg-quality support (like melatonin), changed the protocol style entirely, and achieved a 700% increase in blastocysts compared to my best previous rounds. Beyond the incredible results, Dr. Makis brings a level of expertise, precision, and reassuring care that is rare to find. He looks at you as an individual, not a statistic, and knows exactly how to pivot when traditional routes fail. If you are looking for a specialist who can turn a difficult prognosis into an overwhelming success, look no further than Dr. Makis. I am incredibly grateful for his care.
  
 
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   Olga 
 111 days ago
 
 
  Dr. Makis Papadopoulos was excellent, professional, and very reassuring throughout the entire process. Thanks to his expertise and guidance, we were able to identify the issue early and take the appropriate steps from the beginning. He took the time to explain everything clearly, answered all our questions with patience, and made us feel comfortable and confident throughout our journey. We truly appreciated his caring approach, professionalism, and dedication. Highly recommended!
  
 
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   Euaggelia 
 122 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist and above all a rare person! He is an approachable and smiling doctor, with excellent medical knowledge, who from the first moment I met him made me feel comfortable and trust him completely, answering every question I had with patience and documenting every answer with scientific studies and articles! The most important thing, however, is that Dr. Makis Papadopoulos is always there on the other end of the line to listen to you and reassure you without a trace of haste, a doctor who truly cares and makes you feel like he is your own person! Makis, thank you very much for everything!!! I am very lucky to have met you!

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   Anastasia 
 129 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist with a human-centered interest. Our collaboration was excellent from the very beginning and he made me feel confident and secure by explaining every step of the process in great detail. I highly recommend him!

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   Fay 
 131 days ago
 
 
  Dr Makis Papadopoulos is very professional, caring and attentive. Very thorough in explaining the whole process throughout every step. Thank you! Highly recommended!!
  
 
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   Christina 
 134 days ago
 
 
  I would like to share my experience with Dr. Makis Papadopoulos, an outstanding gynecologist and scientist. We first connected in the summer of 2024, while he was based in Germany, through a mutual acquaintance, following a particularly challenging period for us. Prior to meeting him, we had gone through repeated unsuccessful attempts of stimulation and fertilization with other gynecologists. Unfortunately, those approaches relied largely on standardized protocols, without sufficient personalization to address the specific needs of my case. From the very beginning, Dr. Makis stood out for his human-centered approach and his willingness to dedicate time to truly understand our situation in depth. With strong, up-to-date scientific knowledge, he approaches every case holistically, focusing on individualized treatment and adapting protocols to the patient's unique needs. Throughout our collaboration, which now spans approximately two years (with a few breaks on our side), he has consistently been available, supportive, and clear in his guidance. He inspired confidence and helped us stay positive even during difficult phases of the journey. Beyond his scientific expertise, what truly sets him apart is his genuine care for the person behind each case: his empathy, honesty, and continuous effort to achieve the best possible outcome. My husband and I are deeply grateful for his support and guidance, and we now feel ready and optimistic to move forward to the next final stage. We highly recommend him to anyone seeking a gynecologist with true expertise, professionalism, and compassion. I would like to share my experience with Dr. Makis Papadopoulos, an excellent gynecologist and scientist. We met in the summer of 2024, when he was in Germany, through a mutual acquaintance, after a particularly demanding period for us. Before meeting him, we had gone through repeated failed attempts at stimulation and fertilization with other gynecologists. Unfortunately, the approaches that had been followed were mainly based on standardized protocols, without the necessary individualization to the specifics of my case. From the beginning, Dr. Makis stood out for his human approach and his willingness to spend time to understand our case in depth. With modern knowledge and scientific training, he approaches each issue multidimensionally, emphasizing the individualization of treatment and adapting the protocols to the real needs of the patient. During our collaboration, which now spans about two years (with short breaks on our part), he was always available, supportive and clear in his guidance. He inspired confidence in us and helped us remain optimistic even in difficult phases. In addition to his scientific competence, what sets him apart is his genuine interest in the person behind each case: his empathy, his honesty and his constant effort to achieve the best possible outcome. My husband and I thank him warmly for his support and guidance and we now feel ready and optimistic to move on to the next final stage. We highly recommend him to anyone looking for a gynecologist with real knowledge, professionalism and humanity.

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   Faidra 
 135 days ago
 
 
  Dr. Makis Papadopoulos is an excellent gynecologist and above all an excellent person! I truly thank him for his support and care during the egg freezing process. Although my case was particularly demanding, he stood by me with patience, knowledge, great experience and real interest. Our communication was direct and human, while his availability at the many appointments made me feel safe at every step. The protocols were designed specifically for me, aiming for the best possible result, while also taking into account the cost of the medications. I recommend him with all my heart to every woman who wants to trust someone for something so important and sensitive for her.

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   Iliana 
 137 days ago
 
 
  I highly recommend Dr. Makis, he is an incredible specialist. My journey was far from easy, encountering several challenges that  made the process feel overwhelming at times. What sets him apart is his willingness to go beyond standard procedures. He developed a specialized, custom protocol, tailored to my situation, which ultimately made all the difference. Beyond his technical expertise, his calm and clear communication kept me grounded throughout the process. I am so grateful for his persistence and high level of care!

Why choose FertUlity?

Because every fertility journey deserves the right support. At FertUlity, we provide science-based fertility care with a human approach. We support every path, from fertility assessment and preservation to modern assisted reproduction.

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Is removal of a uterine fibroid always necessary?

01/02/26

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Endometriosis & Fertility

What is it

Symptoms

Affect

Treatments

FAQ

What Is Endometriosis?

Symptoms & Diagnosis

Main Symptoms

Examinations (Ultrasound, Laparoscopy)

Transvaginal Ultrasound (TVUS)

Magnetic Resonance Imaging (MRI)

Laparoscopy (diagnostic):

How Does It Affect Fertility?

Decreased Conception Rate (15% vs 30%)

Egg Quality & Inflammation

Modern Treatments for Endometriosis

Medications

Surgical Removal (Laparoscopy / Robotic)

IVF & Other Assisted Reproductive Techniques

When to Choose IVF

Mitochondrial Replacement Therapy (MRT) – Clinical Trials in Greece

Endometriosis & Fertility

How long does it take to diagnose endometriosis?

Can there be endometriosis without pain or symptoms?

How does endometriosis affect the fallopian tubes?

Can I conceive naturally with mild endometriosis?

How much does age affect IVF success with endometriosis?

Can diet affect endometriosis symptoms?

Is there a risk of recurrence after surgery?

Can egg freezing be done in women with endometriosis?

Does endometriosis affect the course of pregnancy?

What alternative treatments are used for endometriosis?

Our Doctors

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

Dr. Maria Oikonomou Obstetrician – Gynecologist

FertulityThrough the Words of our Parents

Learn More About IVF & Fertility

Is removal of a uterine fibroid always necessary?