A groundbreaking longitudinal study spanning three decades and involving over four million women in England has uncovered compelling new insights into the reproductive outcomes of those affected by endometriosis-associated infertility. Contrary to the prevailing assumption that endometriosis invariably diminishes fertility prospects, this large-scale research has demonstrated that women suffering from infertility linked to endometriosis are significantly more likely to conceive than those facing infertility from other etiologies. These findings herald a paradigm shift in reproductive medicine, offering renewed hope and critical data to millions of women worldwide struggling with this enigmatic condition.
The study was unveiled at the 41st Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), one of the foremost global platforms for cutting-edge reproductive science. This extensive population-based research was orchestrated by the EU FEMaLe consortium (Finding Endometriosis through Machine Learning), led by Dr. Lucky Saraswat of the University of Aberdeen, in collaboration with specialists at the University of Edinburgh. By mining an unprecedented dataset that integrates primary care, secondary care, and maternity records over a 30-year span—from 1991 to 2020—the team conducted the largest and most comprehensive analysis addressing the intersection of infertility and endometriosis to date.
Endometriosis is a chronic gynecological disorder characterized by the aberrant growth of endometrial-like tissue outside the uterine cavity, frequently precipitating debilitating pelvic pain and compromised fertility. Worldwide, it affects approximately 190 million women and is a leading cause of female infertility. Despite its high prevalence, endometriosis remains notoriously underdiagnosed, in part due to nonspecific symptoms and diagnostic delays. This study’s scope and duration have enabled a rare examination of the natural history and reproductive trajectories of affected women with an unparalleled level of granularity and clinical relevance.
.adsslot_eru6GstKC0{width:728px !important;height:90px !important;}
@media(max-width:1199px){ .adsslot_eru6GstKC0{width:468px !important;height:60px !important;}
}
@media(max-width:767px){ .adsslot_eru6GstKC0{width:320px !important;height:50px !important;}
}
ADVERTISEMENT
The cohort encompassed 4,041,770 women aged between 13 and 50 years who sought medical attention in England for infertility or symptoms potentially attributable to endometriosis. Of these, 245,994 presented explicitly with infertility issues, while 111,197 had surgically confirmed endometriosis diagnoses, established via definitive procedures such as laparoscopy or laparotomy. The overall prevalence of female infertility stood at 48.9 per 1,000 women across the study period, peaking among those between 30 to 39 years old—an age range critical to reproductive potential and clinical decision-making.
Intriguingly, among the women identified with infertility, 6.1% (14,904) had a surgical diagnosis of endometriosis. Notably, 57.4% of this subgroup experienced infertility prior to receiving their endometriosis diagnosis, underscoring the persistent challenge of delayed recognition even in symptomatic individuals. This temporal disconnect highlights the urgent need for improved diagnostic tools and clinical vigilance to expedite identification and management of endometriosis in patients presenting with fertility disruptions.
Statistical analysis reaffirmed a robust association between endometriosis and infertility: women grappling with infertility were found to be more than twice as likely to have endometriosis diagnosed compared to those without fertility concerns. This correlation aligns with longstanding clinical observations, reinforcing the role of endometriosis in disrupting normal reproductive physiology through mechanisms such as impaired ovulation, pelvic adhesion formation, and altered immune and inflammatory environments.
Yet, when dissecting pregnancy outcomes among women with infertility, a counterintuitive yet compelling revelation emerged. Those whose infertility was linked to endometriosis demonstrated a fourfold greater likelihood of achieving conception relative to women whose infertility stemmed from other causes—be it ovulatory dysfunction, tubal pathology, or unexplained origins. Overall, 40.5% of women with an endometriosis diagnosis achieved at least one pregnancy during the longitudinal follow-up, a figure that challenges generalized perceptions of inevitable infertility associated with the disease.
Dr. Saraswat elaborated on these surprising findings by suggesting variability in disease phenotype and severity as a critical factor influencing reproductive potential. Women with milder manifestations of endometriosis may retain robust fertility, especially if the condition is identified and managed proactively. Surgical intervention, particularly laparoscopic excision or ablation, has demonstrated moderate-quality evidence of enhancing pregnancy rates, possibly through restoration of pelvic anatomy and reduction of localized inflammation.
Furthermore, heightened awareness among women diagnosed with endometriosis about the reproductive implications of their condition may prompt earlier and more assertive fertility consultations and treatments, thereby improving conception likelihood. This underscores the importance of timely diagnosis and patient education in optimizing fertility outcomes, as well as the multifactorial nature of reproductive success that encompasses age, disease burden, and treatment modalities.
The study’s robust dataset and longitudinal design enable a nuanced understanding of infertility trajectories in the context of endometriosis, delivering invaluable evidence to inform clinical counseling. Women newly diagnosed with endometriosis can now receive more precise prognostic information relating to the probability of infertility, the potential for successful conception, and how these outcomes compare with other infertility etiologies. Such evidence-based guidance is essential to empower patients in reproductive decision-making and to tailor therapeutic strategies to individual risk profiles and aspirations.
Beyond immediate clinical implications, these insights pave the way for future research endeavors to elucidate the interplay between disease stage, anatomical site of lesions, surgical management, and assisted reproductive technologies in shaping fertility outcomes. Understanding the heterogeneity of endometriosis and its impact on reproductive biology at a molecular and systemic level remains a critical frontier in reproductive medicine.
Professor Dr. Anis Feki, Chair-Elect of ESHRE, emphasized the study’s significance, highlighting how it offers reassurance to patients burdened by endometriosis-related infertility and reinforces the imperatives of early diagnosis and personalized treatment strategies. This research contributes to dismantling the stigma and fatalism often associated with endometriosis, fostering a more hopeful and scientifically grounded narrative for affected women.
The findings have been submitted for publication in Human Reproduction, a premier journal in reproductive biology and medicine, ensuring dissemination to global scientific and clinical communities. This study exemplifies the transformative potential of big data and machine learning methodologies in unraveling complex bio-clinical phenomena, heralding a new era of precision reproductive healthcare.
In sum, this landmark investigation not only validates the link between endometriosis and infertility but crucially delineates the nuanced reproductive prospects for these women. It calls for enhanced diagnostic acumen, individualized clinical pathways, and sustained research investment to unravel the intricacies of endometriosis and optimize fertility outcomes, transforming the reproductive landscape for millions worldwide.
Subject of Research: Reproductive outcomes and fertility potential in women with endometriosis-associated infertility based on a 30-year national population study.
Article Title: Not specified in the source content.
News Publication Date: 2 July 2025
Web References:
https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Overview,period%20and%20last%20until%20menopause
References:
[1] Saraswat, L., et al. (2025). Infertility and endometriosis: a 30-year long national population-based study of prevalence, association and pregnancy outcomes. Human Reproduction.
[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.
[3] World Health Organization. (2023). Endometriosis.
Image Credits: Not provided.
Keywords: Endometriosis, Infertility, Reproductive biology, Gynecological disorders, Fertility outcomes, Population-based study, Epidemiology, Surgical diagnosis, Laparoscopy, Assisted reproduction, Women’s health.
Tags: endometriosis and infertilityendometriosis awareness and treatmentESHRE annual meeting insightsEU FEMaLe consortium studyfertility prospects for endometriosis sufferersgroundbreaking research on infertilitylongitudinal study on endometriosismachine learning in reproductive healthpregnancy rates in endometriosis patientsreproductive medicine advancementsreproductive outcomes for women with endometriosiswomen’s health and reproductive research
