How endometriosis can cause fertility-related issues There are four reasons for decreased fertility Ovulatory infertility: Altered growth of follicles due to inflammation and hence altered ovulation or hindrance in ovulation. Tubal factor infertility: Endometriosis causes inflammatory reaction which causes abnormal fusion between ovaries, tubes, uterus and bowels. The tubes may become distorted, swollen and unhealthy Abnormality in the endometrial receptivity: The inner lining of the uterus fails to provide a favorable environment for implantation. Immunological infertility: The inflammatory reaction in the pelvis due to endometriosis releases many negative factors called reactive oxidative species-ROS- that cause oxidative stress to both the oocytes (eggs) and sperms. The gametes (eggs and sperms) are very sensitive to this oxidative stress and cannot function properly. Treatment If the disease is minimal or mild, tubes are open, good semen parameters, the age of female partner is less than 32 years and duration of infertility is less than three years, then controlled ovarian stimulation combined with intrauterine insemination of semen (IUI) is the treatment of choice. This treatment can be repeated upto three to six cycles, addition of further cycles of IUI does not benefit the couple and they need to proceed for in vitro fertilisation or IVF. In moderate and severe disease: Surgical resection of endometriomas (chocolate cyst) and burning down of all endometriotic spots in the pelvis, meaning that complete removal of endometriosis if possible, should be the aim to improve chances of conception. The surgery is followed by either IUI or directly to IVF/ICSI (test tube conception)if at the time of surgery the tubes are found to be damaged due to the disease. A word of caution here is that endometriosis is an ongoing process till a woman is menstruating every month and so it has a high recurrence rate. Hence it is wise to follow up the surgery with either IUI or IVF within six months of surgery. It is important to get yourself examined if you are suffering from pain in the pelvis either related or unrelated to periods, that is affecting your quality of life or if your facing difficulty in conceiving as endometriosis could be a diagnostic possibility and it needs to be treated sooner than later to give you maximum chances of achieving a pregnancy..Best Fertility Care Centre , Maternal & amp; Child Health Care Centre , Advanced Fertility Care Centre , Ashwini Hospital & amp; Fertility Centre , Moondrumavadi K.Pudur Madurai-07, Low Cost IVF & amp; ICSI Centre, Normal Vaginal Delivery Rs.35000/- (including medicines) LSCS Rs.50000/- (including medicines)