Does endometriosis always cause infertility?

No. Many women with endometriosis conceive naturally. But it can reduce fertility, depending on severity, by causing scarring, blocked or distorted tubes, ovarian cysts (endometriomas) and inflammation that affects eggs and implantation. Options depend on your stage, age and symptoms: monitoring and trying naturally in mild disease, surgery in selected cases, IUI with stimulation for milder disease, or IVF when it's more advanced or other treatments haven't worked. Surgery on ovarian endometriomas can lower egg reserve, so it's a decision to take carefully with a specialist. Painful periods that stop you from daily life deserve an evaluation regardless of fertility plans.