What tests check infertility when endometriosis is suspected?

When infertility and suspected endometriosis overlap, we usually evaluate two things in parallel: whether there’s an underlying fertility factor (ovulation, sperm, tubal/uterine issues) and whether endometriosis or adenomyosis is likely contributing through inflammation, adhesions, or anatomic distortion. The workup often starts with a detailed history of cycle patterns, pain, bowel and bladder symptoms, prior pregnancies or losses, and past surgeries. That symptom pattern can help us target the right testing instead of repeating basic tests that came back normal.

Testing commonly includes pelvic imaging (typically a high-quality transvaginal ultrasound and, when indicated, expertly interpreted MRI) to look for endometriomas, signs of deep disease, adenomyosis, and other pelvic conditions that can affect implantation or egg pickup. A fertility evaluation may also include ovarian reserve and hormone labs, confirmation of ovulation timing, and assessment of the uterine cavity and fallopian tubes, for example with contrast-based imaging, plus a semen analysis for your partner. In selected patients, we also look for coexisting issues that can complicate fertility or mimic endometriosis symptoms, such as thyroid dysfunction, PCOS patterns, autoimmune overlap, or other whole-body factors that can amplify inflammation.

It’s important to know that imaging and labs can strongly raise or lower suspicion, but endometriosis is ultimately confirmed by tissue diagnosis when surgery is performed. Biopsy results depend on sampling and surgical expertise. If you share what testing you’ve already had and your main symptoms, our team can review your records, identify what’s missing (if anything), and map out the most efficient next steps, whether that’s further evaluation, fertility planning, or considering excision surgery as part of a fertility-focused strategy.