Endometriosis is a chronic inflammatory gynecological disease that most commonly affects women of reproductive age. It is defined by the presence of benign functional endometrial tissue outside of the uterine endometrium. The localization of endometrial tissue, its macroscopic appearance, symptoms and their severity, and the response to treatment are highly variable. The gold standard for diagnosing endometriosis is laparoscopic surgery. Alongside dysmenorrhea, dyspareunia, metrorrhagia, and chronic pelvic pain, patients with endometriosis often encounter reduced fertility and infertility. Infertility is defined as the inability to achieve pregnancy after at least one year of regular unprotected intercourse, while reduced fertility refers to achieving pregnancy after a longer time than expected for fertile couples. The relationship between endometriosis and infertility is clinically recognized and scientifically proven, although the clear causal link remains unknown. Potential causes of infertility associated with endometriosis are diverse, including chronic inflammation and pelvic adhesions, hormonal and immune disorders, destruction of healthy ovarian tissue and reduction of ovarian reserve, fallopian tube damage, and reduced endometrial receptivity, among others. The approach to treating infertility in women with endometriosis varies greatly and depends on factors such as age, disease localization and its extent, associated conditions, the presence of other symptoms, ovarian reserve, and previous surgical interventions. In patients with minimal and mild endometriosis, the likelihood of spontaneous conception is only slightly lower compared to couples with unexplained infertility. Therefore, an expectant approach is recommended for these patients. Medical treatment has proven effective in managing pain caused by endometriosis, achieving anovulation, and improving the quality of life. In contrast, there is no evidence that pain medication improves fertility. Due to discrepancies in the literature regarding the surgical approach to endometriosis and infertility associated with endometriosis, professional organizations have issued guidelines to facilitate the approach to women who could benefit from surgical treatment to reduce their symptoms and improve fertility. In vitro fertilization (IVF) is unequivocally the most effective therapy in treating infertility associated with endometriosis. IVF maximizes fecundity, particularly in patients with moderate and severe endometriosis where distorted pelvic anatomy is present.