What should a fertility workup include with endometriosis?

A fertility workup with known or suspected endometriosis evaluates egg supply, ovulation, sperm, and pelvic anatomy, including whether endometriosis or adenomyosis may affect fertility through inflammation, adhesions, or distortion that interferes with egg pickup or implantation. We begin by reviewing cycle patterns, pain, bowel and bladder symptoms, prior pregnancies or losses, past surgeries, and previous results to target testing and avoid unnecessary repetition.

Core tests often include ovarian reserve assessment with AMH bloodwork and an antral follicle count to estimate egg supply, high-quality transvaginal ultrasound to assess the uterus and ovaries for endometriomas, adenomyosis, and other conditions, and sometimes expertly interpreted MRI to map suspected deep disease. Other testing assesses hormone levels, ovulation timing, the uterine cavity, and whether the fallopian tubes are open using contrast-based imaging such as HyCoSy, alongside a partner’s semen analysis because male-factor issues are common and can change the plan.

In selected cases, we also evaluate thyroid dysfunction, PCOS patterns, autoimmune overlap, or other whole-body factors that may complicate fertility, mimic symptoms, or amplify inflammation. HyCoSy checks tubal openness rather than reliably detecting endometriosis, and imaging and labs can inform suspicion without excluding disease when normal; when surgery is performed, tissue examination can confirm endometriosis, although biopsy results depend on sampling and surgical expertise.

We use the findings and your timeline to weigh timed intercourse, IUI, other fertility treatment, or surgical evaluation, including whether excision could help when endometriosis-related anatomy is a barrier. If you’d like, you can schedule a consultation with our team to review your records, identify any missing tests, interpret results, and plan efficient next steps for evaluation or fertility-focused care.