Endometriosis affects 200 million women globally and accounts for 30-50% of infertility cases, yet the average diagnosis takes 5-12 years because pain is normalized and imaging misses superficial lesions. Dr. Renato Tomioka explains how specialized ultrasound and MRI now enable earlier diagnosis, discusses treatment decisions balancing fertility and symptom relief, and reveals why maternal age—not IVF itself—is the dominant factor in egg quality, with aneuploidy rising from 35% at age 31 to 85% by age 42. Endometriosis lesions produce their own estrogen via aromatase overexpression and exhibit progesterone resistance, allowing tumor-like growth despite being benign tumors without metastatic potential.