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Introduction: We are reporting a case of spontaneous conception and viable birth in a woman diagnosed with stage III pelvic endometriosis and bilateral tubal blockade. Case: A 30-year-old woman was investigated for primary infertility and was diagnosed with stage III pelvic endometriosis, extensive distortion of pelvic anatomy and bilateral tubal damage on diagnostic laparoscopy and chromotubation. Patient was advised in vitro fertilization; however, she chose otherwise and conceived spontaneously, delivering a healthy baby by cesarean section at term. Discussion: Spontaneous conception rates amongst women with advanced endometriosis nearly approaches zero; hence, expectant management is not recommended for associated infertility. Despite being and isolated case, this report raises questions regarding the association of infertility even with advanced endometriosis and also highlights the beneficial effect pregnancy has on endometriosis. [ABSTRACT FROM AUTHOR]