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Are you an endometriosis warrior struggling to conceive?
Try not to get discouraged.
Fortunately, getting pregnant with endometriosis is possible. It may just take longer or involve medical treatment.
An estimated 10% to 15% of women of childbearing age suffer from symptoms of endometriosis. In fact, it’s estimated that up to 50% of infertile women struggle with the disease.
The good news is that with modern medical advancements, you have options for treatment. Some Assisted Reproductive Techniques (ARTs) can even help you with TTC.
Keep reading to learn all about how endometriosis affects pregnancy and fertility
Key Takeaways
- Endometriosis is a common but treatable disease among women. Common symptoms of the disease include severe pain in the pelvic organs and infertility.
- If you suffer from endometriosis, it may be challenging to conceive naturally. But you can still get pregnant with the disease!
- If you have endometriosis, you have an increased risk of pregnancy complications.
- There are medical and surgical treatments that can help with the symptoms of endometriosis. Assisted reproductive techniques can help you conceive with endometriosis.
- Many women battling the disease have had successful pregnancies. There is hope for you too!
What Is Endometriosis?
Your endometrium is a key player in your reproductive system. It’s the tissue that lines your uterus (where a fetus develops).
If you have endometriosis, you have extra tissue (called glands or stroma) that forms outside of the uterus. This tissue can cause chronic inflammation and pelvic pain if not treated. And it affects your ability to reproduce.
Before an endometriosis diagnosis, some women may think this pelvic pain is due to their normal menstrual cycle. But for many women with the condition, the pain is severe.
At this point, no research has proven the exact cause of endometriosis.
How Does Endometriosis Affect Fertility?
Endometriosis causes extra tissue to develop outside of the uterus that can harm your reproductive organs. Plus, the treatment for the pain – medical or surgical – also impairs fertility.
Here are some fertility complications you may experience if you have endometriosis:
Ovarian cysts
The swelling caused by endometriosis can spread to the ovaries, creating cysts. These cysts are called endometriomas, and they aren’t your typical ovarian cysts. They can stop follicles from releasing an egg by acting as a barrier. Cysts can also keep eggs from traveling through the fallopian tubes. Either of these issues will lead to infertility.
Adhesions
The extra tissue caused by endometriosis can lead to adhesions (scars). Adhesions cause tissues to stick together inside your body.
When trying to conceive, this scar tissue poses a significant challenge. It can stop an egg from reaching the uterus and prevent sperm from reaching the egg.
Imagine a traffic jam where your car is stuck with no route out. This is what happens to an egg or a sperm when it encounters an adhesion.
Poor egg quality
There is evidence that endometriosis also affects egg quality.
One study involved women without endometriosis receiving donor eggs from women with endometriosis. These women had an increased rate of implantation failure compared to the women receiving eggs from donors without endometriosis. This reveals that it’s not just the internal environment of patients with endometriosis that is affected. Their egg quality is also negatively affected.
Painful intercourse
A common (and annoying) symptom of endometriosis is pain during sex. When trying to conceive, this pain makes the process very unpleasant or nearly impossible. In some cases, it might also cause you to avoid sex altogether.
Learn more: When to have sex to conceive?
Medication
If you have endometriosis, the pain can be mild to unbearable. Many women treat the pain and other symptoms by taking hormonal birth control. This leaves sufferers with a tricky decision—treat the pain or push through it for the sake of TTC?
Mild or Minimal Endometriosis vs. Moderate or Severe Endometriosis
You may think that your chances of getting pregnant with endometriosis aren’t affected if your endometriosis symptoms are mild.
But that’s not true.
Even if your fallopian tubes and ovaries aren’t affected, you could still experience infertility.
There is some controversy on the extent of the effect in mild cases. Even so, there will still be an impact on your chances of conceiving.
If you have endometriosis, here are the main ways your fertility may suffer:
- Poor egg quality due to pelvic adhesions and endometriomas. Poor egg quality can lead to chromosomal abnormalities and miscarriage.
- Tissue blocks the fallopian tube from transporting the egg. If the egg can’t travel through the fallopian tube, it has no chance of meeting the sperm.
- The overgrowth of endometrial tissue or adhesions blocks sperm. Again, the sperm and egg are kept from meeting. Sperm, a “foreign” substance in the female, is also more likely to be killed off.
- Inflammation and a higher number of antibodies in the endometrium make successful implantation less likely.
How Does Endometriosis Affect Pregnancy?
If you are TTC with endometriosis, you should know the extra risks. There are four main reproductive issues that women with endometriosis face:
- Altered uterine environment: This refers to the abnormal makeup of the uterus due to the extra tissue. It can lead to growth restriction and spontaneous miscarriage.
- Inflammation: This is the body’s automatic response to damaged tissue. It can lead to gestational diabetes, hypertension, and preterm birth.
- Inadequate uterine contractility: This refers to the uterus’ reduced ability to contract. It can lead to preterm birth, miscarriage, and growth restriction.
- Defective placentation: This refers to problematic development or positioning of the placenta. It can lead to miscarriage, preterm birth, and growth restriction.
Trying to Conceive With Endometriosis
Reading all this may all sound a little disheartening. But there’s good news! Getting pregnant with endometriosis is definitely possible. There are just some extra steps you may need to take.
IUI (intrauterine insemination)
An IUI involves having the sperm inserted near the cervix. This will be done at an optimal time during ovulation. This procedure is usually done at the doctor’s office. With today’s medical advancements, you can also find at-home insemination kits.
IVF (in vitro fertilization)
IVF is a more invasive form of assisted reproduction than IUI. It involves a procedure to retrieve your eggs. Those eggs are then combined with the sperm sample in a petri dish to fertilize. Then the fertility specialist will transfer a healthy embryo close to the uterus via a catheter.
The remaining embryos can be frozen for future use. According to one study, IVF led to higher chances of pregnancy than IUI for patients with endometriosis. But it is a more costly procedure. So definitely check with your insurance company to see what they cover.
Clomiphene citrate
Your doctor may prescribe clomiphene citrate. This helps increase the number of mature eggs your ovaries produce in a given cycle.
Typically, a woman produces just one mature egg each cycle. But with Clomid, they can create multiple mature eggs. A fertility specialist can use an ultrasound to check how many eggs are maturing.
Egg freezing
Endometriosis can affect your ovarian reserve. For this reason, consider freezing your eggs. This involves a relatively simple procedure. Around ovulation, your mature eggs are harvested and frozen. You can get an AMH test done to check your egg supply.
Medical and Surgical Treatments for Endometriosis
There are treatments available to help with the pain. You can also undergo surgery to treat or remove the tissue.
- Medication: You can take OTC drugs like Ibuprofen or Aleve to lessen the pain caused by endometriosis. For some women, birth control may help prevent more tissue from growing outside the endometrium.
- Surgery: If you have more severe endometriosis, you may consider surgery. Two types of surgery can be done to either remove or destroy the tissue and scar tissue. A laparoscopic surgery is less invasive than a laparotomy surgery. It is essential to know that surgery could cause extra scarring that may lead to infertility.
What Is the Outlook for Women With Endometriosis?
If you have endometriosis, you will likely experience infertility. You also have a greater chance of miscarriage and ectopic pregnancy than women without the disease.
If you choose not to get treated, there is a chance that your lesions could regress on their own. This occurs in about one-third of women with endometriosis.
If you get surgery for endometriosis, estimates of symptoms returning are between 6-67%. Therapy can provide relief. But between 5% and 59% of women will still experience pain at the end of the therapy session.
Success Stories: Endometriosis Warriors Who Got Pregnant
The good news is that many women with endometriosis have successfully conceived. Here are some celebrities who have gotten pregnant with the disease.
Chrissy Tiegan: This famous cookbook star and wife of John Legend had 3 children of her own and one surrogate. She also had laparoscopic surgery to treat her endometriosis.
Tia Mowry: This actress and YouTube star has had several surgeries for her endometriosis. But she gave birth to a son and a daughter.
Padma Lakshmi: This famous actress suffered from terrible pain her whole life. But she welcomed her daughter in 2010. She also founded the Endometriosis Foundation of America.
Mandy Moore: This famous actress gave birth to her first son in 2021 and her second son in 2022. She almost had surgery for her suspected endometriosis before she found out she was having her first baby.
Amy Schumer: This American comedian suffers from endometriosis. She gave birth to her son in 2019.
FAQs
Your odds of getting pregnant naturally with endometriosis depend on how severe your endometriosis is. If you have mild endometriosis, your fertility may not be as impacted and your odds of conceiving would be similar to those of other healthy women at your age. If your endometriosis is more moderate to severe, then your odds of conceiving naturally will likely be lower. The good news is that nowadays, women with endometriosis can increase their odds of getting pregnant with helpful assisted reproductive technologies like IVF.
If you have stage 1 endometriosis it may slightly affect your fertility but not as much as it would if you had more moderate or severe endometriosis. But at the end of the day, it all comes down to your overall health. So to have a better idea of your unique fertility odds and options, check in with your doctor or a fertility specialist.
Yes, for some women, pregnancy can make symptoms of endometriosis feel worse. This is because the growing uterus can put extra pressure on the lesions and scar tissue as well as other pelvic organs that may be affected by the disease. For other women, it’s possible to not notice any true differences in symptoms while pregnant. The extent to which pregnancy impacts your endometriosis really depends on your unique pregnancy and how severe your symptoms are to begin with. If you have concerns, talk to your doctor about ways that you may be able to lessen the impact of any aggravated symptoms.
If you have endometriosis, it’s typically better to get pregnant sooner rather than later. Even without endometriosis, a woman’s fertility begins to decline more quickly after age 35. And endometriosis can speed this decline up since the condition greatly affects your ovarian reserve (the number of healthy eggs you have left). If you’re not ready to get pregnant yet and want to preserve your egg health, you could do an egg retrieval.
Stage 4 endometriosis refers to severe endometriosis. This severity is determined by how many ovarian cysts you have as well as how severe and widespread the scar tissue is.
In one study, women with laparoscopically confirmed endometriosis had a 19% higher risk of premature death. This was in comparison to women without endometriosis, after adjusting for age. But always take statistics like this with a grain of salt because endometriosis is only one aspect of your overall health. If you have concerns about your life expectancy with this condition, talk to your doctor for a better understanding of your unique circumstances.
No, a hysterectomy cannot cure endometriosis. Although, it can help with relieving symptoms of endometriosis. For women who undergo surgery for endometriosis, there’s a chance from anywhere between 6% and 67% of the symptoms returning.
There are generally only 4 stages recognized when diagnosing endometriosis. These are minimal, mild, moderate, and severe. Each stage varies in the extent of ovarian cysts and the severity and prevalence of scar tissue.
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