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Bowel endometriosis is typically associated with deep endometriotic lesions in the pelvis and endometriomas, making it difficult to establish the precise impact of intestinal endometriotic lesions on fertility. Very limited data are available on rates of spontaneous conception in women with bowel endometriosis. Infertile patients with bowel endometriosis may either undergo surgery to enhance fertility or artificial reproductive techniques (ART) such as in vitro fertilization (IVF). Interpretation of the available data on fertility outcomes after colorectal surgery for deep endometriosis is difficult as the overall quality of the studies is poor. Furthermore, several studies do not distinguish patients with real infertility from those wishing to conceive without proven infertility. Patients with bowel endometriosis undergoing ART must be informed of the potential risks (e.g., bowel complications such as perforation and severe infection) during oocyte retrieval and pregnancy. Persistence of pelvic pain, intestinal symptoms due to delaying surgery as well as the progression of the degree of intestinal wall infiltration are well recorded. However, ART has some advantages in women with bowel endometriosis because it shortens the interval to conception and avoids the negative impact of postoperative complications (such as anastomotic leakage or deep pelvic abscess) on fertility. It is well established that bowel surgery leads to relief of pain and intestinal symptoms caused by endometriotic lesions. In contrast, the usefulness of bowel surgery to increase the likelihood of spontaneous conception is yet to be established.