What is endometriosis?
Endometriosis is a condition in which tissue resembling the lining of the uterus (endometrium) is found outside the uterine cavity. The most common locations are the ovaries (where it can form cysts called endometriomas), the pelvic peritoneum, the fallopian tubes, and the bowel or bladder. The disease is staged from I (minimal) to IV (severe) based on extent and location of lesions, though stage does not always correlate well with symptoms or fertility impact.
Definitive diagnosis historically required laparoscopy with visual confirmation and biopsy. Current ACOG guidance recognizes that clinical diagnosis based on history, examination, and imaging (transvaginal ultrasound or MRI) is reasonable in many cases, particularly when surgery is not otherwise indicated. Symptoms include painful periods, painful intercourse, pelvic pain, and infertility — though some women with significant disease have minimal or no symptoms.
How common is it among IVF patients?
Endometriosis is reported as a contributing diagnosis at 431 of 458 US clinics in the most recent CDC data, with an estimated 53,662 IVF cycles annually citing endometriosis as a diagnosis.
The reported IVF prevalence is somewhat lower than the population prevalence in fertility populations because endometriosis often coexists with other diagnoses (such as male factor or DOR), and the cycle may be coded primarily under the most clinically relevant cause. Many IVF patients with endometriosis are diagnosed during their fertility evaluation rather than before.
How endometriosis affects IVF outcomes
The effect of endometriosis on IVF outcomes is moderate and varies by stage. Severe endometriosis (stage III or IV) has been associated with somewhat lower live birth rates per IVF cycle compared to other diagnostic categories, while mild to moderate endometriosis may have outcomes closer to the overall average. The proposed mechanisms include reduced ovarian reserve when endometriomas are present, altered follicular environment, and effects on endometrial receptivity.
Endometriomas pose a particular dilemma. Surgical removal can reduce ovarian reserve (some normal ovarian tissue is removed with the cyst), while leaving them in place may impact stimulation response and complicate egg retrieval. ASRM guidance is nuanced: for asymptomatic endometriomas in women approaching IVF, surgery is generally not recommended unless the cyst is large enough to interfere with retrieval or there is suspicion of malignancy. For symptomatic endometriomas or those associated with significant pain, decisions are individualized.
What approaches are commonly discussed
For endometriosis-associated infertility, treatment depends on stage, symptoms, age, ovarian reserve, and patient preferences:
- Surgical management. Laparoscopic excision or ablation of endometriotic lesions has been associated with modest improvement in natural pregnancy rates for stage I/II disease. The effect on subsequent IVF outcomes is less clear and is typically not the primary indication for surgery in IVF candidates.
- IVF. Often the most effective treatment for endometriosis-associated infertility, particularly when other factors (age, DOR, male factor) are also present. IVF bypasses many of the proposed fertility-affecting mechanisms of endometriosis.
- Pre-IVF GnRH agonist suppression. Some studies have suggested benefit from 3-6 months of GnRH agonist suppression before IVF in patients with severe endometriosis, but evidence is mixed and this approach extends time-to-treatment.
- Endometrioma management before IVF. Decisions are individualized based on cyst size, ovarian reserve, symptoms, and prior surgical history.
Questions to ask your fertility specialist
If endometriosis is part of your diagnosis, the following questions can help structure the conversation:
- What is the suspected stage of my endometriosis based on imaging and history?
- Do I have endometriomas, and if so, what are you recommending and why?
- How does endometriosis affect outcomes in your patient population specifically?
- Do you recommend pre-IVF medical suppression in my case? Why or why not?
- If I have endometriomas and we proceed to retrieval, how do you handle the technical challenges?
- What can I expect for AMH and antral follicle count over time given my endometriosis?
US fertility clinics with the highest reported endometriosis cycle volume
The list below ranks US fertility clinics by estimated annual cycles citing endometriosis as a diagnosis, derived from each clinic's CDC-reported total cycle count multiplied by the percentage of cycles citing this diagnosis. Volume is a signal that a clinic regularly treats this diagnosis. It is not a measure of success rate or quality. CDC does not publish per-diagnosis success rates at the clinic level, so a "best clinic for endometriosis" cannot be derived from this dataset alone.
How we computed these numbers
The clinic-level numbers on this page come from the CDC's National ART Surveillance System (NASS), specifically the 2022 ART Surveillance Report, which is the most recent dataset available. CDC publishes these reports on a two-year lag.
Estimated annual cycles for this diagnosis are computed by multiplying each clinic's total reported cycles by the percentage of cycles in which endometriosis was cited as a diagnosis. The CDC reports these percentages but does not publish absolute cycle counts per diagnosis, so the figures here are estimates.
A single IVF cycle can have multiple diagnoses recorded. A patient with both male factor and diminished ovarian reserve would have both diagnoses counted, which is why the percentages reported by clinics often sum to more than 100%. The "share of all CDC IVF cycles" stat above is therefore an approximation of how often this diagnosis appears in any cycle's record, not a percentage of cycles where it is the sole cause.
Editorial content on this page was last reviewed on April 30, 2026. We aim to update each diagnosis page when major guidelines from ASRM, ACOG, AUA, the Endocrine Society, or related professional bodies are revised.
Sources
- American College of Obstetricians and Gynecologists. Management of Endometriosis. ACOG Practice Bulletin No. 114.
- Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion.
- Centers for Disease Control and Prevention. 2022 Assisted Reproductive Technology National Summary Report.