For many women living with endometriosis, one of the biggest questions is whether they can achieve a pregnancy naturally and what factors may influence their chances. A 2025 study published in the Journal of Minimally Invasive Gynecology explored which factors were associated with achieving a live birth after spontaneous conception following endometriosis surgery. Researchers Nguyen, Marshall, and colleagues looked at 100 women with infertility who underwent surgery for endometriosis, comparing outcomes among patients who had complete excision versus those who underwent ablation with or without excision.

The results offer encouraging news. Of the 100 women studied, half achieved spontaneous conception, and 40 ultimately had a live birth within one year of surgery. Two factors stood out as being associated with a higher chance of live birth. First, age mattered: women younger than 35 at the time of surgery were more likely to achieve a live birth compared with older women. Second, and perhaps most importantly, complete excision of endometriosis was associated with a significantly higher likelihood of live birth. Women who underwent complete removal of their endometriosis had a 4.1-fold increased likelihood of achieving a live birth compared with those whose disease was not completely excised.

The study also revealed several other interesting findings. Body weight did not appear to influence outcomes, meaning women who were overweight or obese had similar rates of spontaneous conception compared with women in the normal weight range. Additionally, the stage of endometriosis did not appear to predict who would achieve a live birth. Pregnancy rates were similar across all stages of disease: 42% (18/32) for AAGL stage I, 32% (8/25) for stage II, 46% (6/13) for stage III, and 42% (8/19) for stage IV endometriosis.

Like any study, this research has limitations. It was a retrospective study, meaning researchers reviewed outcomes from patients who had already undergone surgery rather than assigning different treatments and following patients forward.  This means there are likely other confounding factors not controlled for that influenced the results.  Additionally the study included only 100 women from a single healthcare system and did not include a comparison group of women who did not have surgery. The authors appropriately caution that larger studies will be needed to confirm these findings. Still, this study adds to growing evidence suggesting that complete excision of endometriosis may improve fertility outcomes for appropriately selected patients.

The takeaway is not that surgery is the right answer for everyone, but that the quality and completeness of surgery matter when surgery is chosen. For patients with endometriosis who are hoping to conceive, this study adds to growing evidence that thorough excision performed by an experienced surgeon can improve the chances of natural pregnancy regardless of the stage of endometriosis. Of course decisions about timing, surgical approach, and whether to pursue fertility treatment should always be individualized, taking into account a patient’s age, symptoms, fertility goals, and overall circumstances. A thoughtful conversation with a specialist who understands both endometriosis and fertility can help patients make the decision that is right for them.

Source Article

Nguyen AD, Marshall HL, Sidle MW, Galaviz VD, Sticco PL, Downing KT. Factors Associated With Spontaneous Conception Leading to Live Birth in Infertility Patients After Endometriosis Surgery. Journal of Minimally Invasive Gynecology. 2025;32(8):718-724. doi:10.1016/j.jmig.2025.03.010. PMID: 40127888.

 https://pubmed.ncbi.nlm.nih.gov/40127888/