Endometriosis can reduce egg freezing success by impacting egg quality and ovarian response, especially when endometriomas (cysts on the ovaries caused by endometriosis) are present. While the egg freeze cycle itself remains largely unchanged compared to cycles in patients without endometriosis, cysts may complicate stimulation and retrieval.

What exactly is endometriosis?

The inner lining of the uterus is called the endometrium, which thickens each month to support a pregnancy. When a pregnancy doesn’t occur, the endometrium sheds to cause a period. In endometriosis, there’s endometrial tissue outside of the uterus, on structures such as the ovaries or the fallopian tubes. This tissue still responds to the hormonal changes that happen with the menstrual cycle, so it thickens and bleeds, but can’t exit the body. This leads to inflammation and scar tissue.

Symptoms vary but are often worse during menstruation. People with endometriosis may have pelvic pain, pain with sex, pain with urinating or bowel movements, as well as heavy or irregular periods. Some women may notice bloating or may have difficulty becoming pregnant.

How does endometriosis affect egg freezing success?

Egg quality may be compromised, particularly when endometriosis affects the ovaries. Studies show women with ovarian endometriosis often have lower antral follicle counts (AFC) and reduced anti-Müllerian hormone (AMH) levels, both indicators of diminished ovarian reserve. Inflammation and oxidative stress caused by endometriotic lesions can impair follicular development and reduce the number of mature eggs retrieved.

Some women experience cramping, bloating, or spotting after egg retrieval, which are all normal post-procedure symptoms. However, these may be more pronounced in patients with extensive disease, larger ovaries, or high egg yield, due to inflammation and pelvic sensitivity.

So what is meant by “egg quality”?

Egg quality refers to the egg’s ability to develop into a healthy pregnancy. Factors that can influence egg quality include having a correct number of chromosomes, maturing properly, and being capable of successful fertilization.

Egg quality can be impacted by inflammation, oxidative stress, or altered ovarian environment (for example, the presence of cysts). As we mentioned, endometriosis will potentially do all of these things, meaning it can lead to a decreased quality or quantity of eggs. However, it’s still very possible to have a successful egg retrieval.

How does endometriosis affect the actual egg freezing procedure?

The procedure itself is generally not altered by endometriosis unless endometriomas are present. Endometriomas can interfere with ovarian stimulation by occupying space and disrupting follicular growth. This may lead to fewer eggs retrieved or dyssynchronous response to medications.

Timing is critical: Starting a cycle when follicles are uniform in size improves outcomes. A cyst present at baseline may skew follicular recruitment.

Surgical removal of endometriomas should be carefully considered. While surgery may improve access and reduce inflammation, it can also damage healthy ovarian tissue and reduce egg reserve and lower egg yield. Egg retrieval requires precision: Providers must avoid puncturing endometriomas during aspiration to prevent infection or rupture.

In summary, endometriosis can make egg freezing more challenging by affecting egg quality, ovarian response, and retrieval conditions, especially if endometriomas are present. However, with an individualized plan and care monitoring, patients with endometriosis can still achieve good outcomes and safely free their eggs.

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Dr. Alison Peck is a double board-certified reproductive endocrinologist and infertility specialist practicing in the San Fernando Valley over the last two decades at HRC Fertility in Encino and Westlake Village. She is deeply passionate about egg freezing, stopping the biological clock, and helping couples conceive through IVF, genetic testing, and third-party reproduction. Known for her compassionate care and scientific rigor, Dr. Peck empowers patients to take control of their fertility journey with clarity and confidence. Her clinical expertise and personal dedication make her a trusted leader in reproductive medicine.