The study analyzed the association between endometriosis and adverse reproductive and perinatal outcomes in women undergoing assisted reproduction (ART) based on 29 cohort studies involving 93,071 women with endometriosis and 1,350,005 controls. Women with endometriosis had a lower clinical pregnancy rate (RR 0.850, 95% CI 0.726–0.994) and a lower live birth rate (RR 0.716, 95% CI 0.9236–0.341). They had an increased risk of preterm birth (RR 1.277, 95% CI 1.187–1.373), placenta previa (RR 2.246, 95% CI 1.759–2.869), caesarean section (RR 1.296, 95% CI 1.165–1.441), low birth weight (RR 1.179, 95% CI 1.050–1.279), stillbirth (RR 1.219, 95% CI 1.032–1.440) and hypertensive disorders of pregnancy (RR 1.169, 95% CI 1.057–1.276). There were no significant differences in the risk of a small or large baby for gestational age, miscarriage, preeclampsia or ectopic pregnancy (all p > 0.05). Subgroup analyzes showed differences by ethnicity, endometriosis stage, and ART method, but the overall results were robust. Endometriosis thus increases the risk of several adverse outcomes after ART.