UPDATED fertility guidance has been issued by the National Institute for Health and Care Excellence, UK, for patients with endometriosis who are struggling to conceive.
The New Guidance
Under new guidelines, clinicals are urged to discuss intervention options with patients, tailoring care based on factors including how long they have been trying to conceive, severity of symptoms, age, ovarian reserve, and any male fertility factors.
The guidance offers a clear treatment pathway: expectant management or surgical treatment may be offered.
Upon failure of the relevant two interventions after two years, intrauterine insemination or IVF will subsequently be discussed.
The update follows feedback received during NICE’s public consultation that resulted in a landmark decision to recognise that endometriosis requires a tailored approach to fertility care.
After hearing from patients, patient groups, clinicians, and professional bodies, the committee reportedly agreed with organisation Endometriosis UK that endometriosis should not fall under unexplained infertility, rather, it requires a distinct fertility pathway.
New guidance also includes blocking fertility clinics from offering unproven add-on treatments and broadening access to NHS-funded fertility preservation beyond cancer patients.
Emerging Research on Endometriosis
Endometriosis affects an estimated 1.5 million people in the UK.
Despite this, NICE commented, many patients have historically encountered confusion and inconsistency when seeking fertility treatment.
It follows that symptoms are incompletely managed and recurrent surgeries are common, a 2026 systematic review and meta-analysis reported.
Analysis revealed that the odds of spontaneous pregnancy after a primary surgery for endometriosis were more than twice as high compared with after re-operation.
Notably, the review found that, for women trying to conceive naturally or via assisted reproductive technologies, re-operation may negatively impact fertility and pregnancy outcomes for people with endometriosis.
NICE said that the new personalised treatment pathway helps ensure that fertility services for patients with endometriosis are more personalised, mitigating variation in care and encouraging equitable access.
References
National Institute for Health and Care Excellence. Endometriosis now has its own fertility pathway in NICE guidance. Available at: https://www.nice.org.uk/news/articles/nice-recommends-new-dedicated-fertility-treatment-pathway-for-endometriosis. Last accessed: 6 April 2026.
National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. Available at: https://www.nice.org.uk/guidance/ng257. Last accessed: 6 April 2026.
Cao M et al. Fertility after endometriosis surgery: a systematic review and meta-analysis comparison of primary versus multiple surgical interventions. Eur J Obstet Gynecol Reprod Biol. 2026;DOI:j.ejogrb.2026.11501.
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