Endometriosis Progression While Trying to Conceive or Using IVF: What the Evidence Says (2025 Review)
WHAT WAS STUDIED?
A 2025 review in Human Reproduction looked at how endometriosis behaves when patients stop hormonal therapy to try naturally, undergo IVF stimulation, and during pregnancy.
- Stopping hormones to try naturally
Hormonal therapy keeps endometriosis suppressed, but it prevents conception. When paused for a typical 12-month natural-conception window, the risk of recurrence or progression is about 10%. Risk grows the longer treatment is stopped. - IVF stimulation and endometriosis
IVF raises estrogen levels up to 10 times higher than in a natural cycle. Reassuringly, most studies show this does not worsen pain or cause endometriomas to grow. The only group that may need closer monitoring is women with deep endometriosis, where limited evidence hints at possible changes. - Pregnancy and lesion changes
During pregnancy, endometriomas, and sometimes deep nodules, can change in appearance, sometimes in up to half of patients. These are usually harmless changes called decidualization. - Obstetric risks
Pregnancy in endometriosis carries slightly higher risks. The most consistent finding is placenta previa, which is about 5–10 times more common in severe disease. A very rare complication, bleeding inside the belly (spontaneous hemoperitoneum), occurs in less than 1%, and is seen more often after IVF in women with deep disease.
WHAT THIS MEANS FOR PATIENTS
Most people with endometriosis can safely try naturally or pursue IVF. The key is personalized planning, weighing natural fertility chances, IVF success, pain control, and risk monitoring. Some fertility specialists may also tailor embryo transfer strategies or stimulation protocols to reduce risks, though evidence is still evolving.
ESSI takeaway: Endometriosis usually requires pausing treatment when trying for pregnancy, which can slightly raise recurrence risk. IVF is safe for most patients, though deep endometriosis deserves closer follow-up. With the right strategy and support, pregnancy is possible for many.
If you have questions about this or you are considering to try for a pregnancy, do not hesitate to contact Dr. Andrea Vidali, Reproductive Endocrinologist, and his fertility team at ESSI.
Written by Emanuela Lazzaroni-Tealdi, MS, Director of ESSI Peer Support and Medical Education
