Endometriosis Typology and Infertility

Rachel Myrer, Bin Yang, Joseph B. Stanford, Christy Porucznik, Leslie V. Farland, Anna Z. Pollack, C. Matthew Peterson, Karen C. Schliep
In: Epidemiology · 2026 · vol. 37(S2) · doi:10.1097/01.ede.0001280108.66822.44 · W7221563351
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A large cohort study found that deep infiltrating and ovarian endometriomas carry the highest infertility risk, while superficial disease carries the lowest, highlighting the importance of endometriosis typology in fertility assessment.

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This retrospective cohort study analyzed data from 461,684 women in the Utah Population Database to evaluate the association between specific endometriosis subtypes and infertility risk. The researchers classified lesions as superficial, ovarian endometriomas, or deep infiltrating disease, using Cox proportional hazards models to calculate adjusted hazard ratios for infertility diagnoses. Results indicated that women with endometriosis faced a significantly elevated infertility risk overall, with deep infiltrating and ovarian endometrioma subtypes carrying the highest hazard ratios compared to superficial disease. This paper is centrally about endometriosis — specifically examining how different anatomical subtypes of the condition correlate with varying levels of infertility risk.

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Background

Endometriosis affects approximately 11% of women of reproductive age and is a significant cause of female factor infertility. Current classification systems inadequately predict infertility diagnoses, highlighting the need for improved classification approaches. Objective: The main objective is to evaluate the relationship between endometriosis subtypes and infertility risk using a large population-based cohort.

Methods

We used a retrospective cohort from the Utah Population Database (1996–2020) including 461,684 women, with 79,600 diagnosed with endometriosis. Endometriosis subtypes were classified as superficial endometriosis (SE), ovarian endometriomas (OE), deep infiltrating endometriosis (DE), and other endometriosis. The primary analysis used Cox proportional hazards models to assess the hazard ratio of infertility diagnosis across endometriosis subtypes.

Results

Women with endometriosis had a significantly higher risk of infertility compared to women without endometriosis (adjusted Hazard Ratio [aHR] 6.07, 95% CI 5.77-6.40). Infertility risk differed by endometriosis subtype, with the highest risk among those with deep infiltrating disease and/or ovarian endometriomas (aHR 9.01; 95% CI: 8.45–9.60), followed by other endometriosis (aHR 5.35; 95% CI: 4.94–5.79) and superficial endometriosis (aHR 4.36; 95% CI: 4.04–4.71).

Conclusion

Endometriosis subtypes demonstrate different infertility risks, with deep infiltrating and ovarian endometriomas associated with the highest risk. These findings suggest the importance of considering endometriosis typology in clinical practice and research, potentially offering a more nuanced approach to patient care and fertility management.

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