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.
But, you are not alone. 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
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?
Getting pregnant with endometriosis can be challenging but not impossible. This is because the extra tissue outside of the uterus can harm your reproductive organs. 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 and create 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. Think of trying to exit a room through a jammed door. Cysts can also keep eggs from traveling through the fallopian tube. Either of these issues will lead to infertility.
The extra tissue caused by endometriosis can lead to adhesions (scars). Adhesions cause tissues to stick together inside your body.
When you are trying to conceive, this scar tissue poses a big problem. It can stop an egg from reaching the uterus. And it can also keep 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 sperm when they run into an adhesion.
- Egg quality
There is evidence that endometriosis also affects the quality of eggs. 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.
- Pain during sex
A common (and annoying) symptom of endometriosis is painful intercourse. You obviously need to have sex to conceive (at least, naturally). So this pain makes TTC very unpleasant or nearly impossible if it causes you to avoid sex.
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 your 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 becoming pregnant with endometriosis aren’t affected if your endometriosis symptoms are mild. Yet, 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.
- Sperm are blocked by the overgrowth of endometrial tissue or adhesions. Again, the sperm and egg are kept from meeting up with each other. Sperm, a “foreign” substance in the female, is also more likely to be killed off.
- Successful implantation is less likely. This is due to inflammation and a higher amount of antibodies in the endometrium.
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 make-up 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 to fertilize in a petri dish. 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 you a medication called clomiphene citrate. This helps with increasing the amount of mature eggs your ovaries produce in a given cycle.
Normally, a woman produces just one mature egg each cycle. But with Clomid, they can produce multiple mature eggs. A fertility specialist can use ultrasound to check how many eggs are maturing.
Egg freezing: Endometriosis can affect your ovarian reserve. For this reason, you may want to consider having your eggs frozen. 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. There are two types of surgery that 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 important 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 the disease.
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.
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.
- 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!