Endometriosis is a painful condition. It has the potential to affect a woman’s fertility. Fortunately, treatments are available.
The lining of your uterus is known as the endometrium. This unique tissue is responsible for menstruation, including when it sloughs off and causes bleeding. This happens when you get your period.
When a woman has endometriosis, this tissue grows in places it shouldn’t. Examples include your ovaries, intestines, or tissue that lines your pelvis.
Here’s an overview of endometriosis, what you need to know if you’re trying to get pregnant, and treatment options.
Overview of endometriosis
The problem with having endometrial tissue in other areas of your body is that the tissue will break down and bleed just like in your uterus. But the blood doesn’t have anywhere to go.
Over time, this blood and tissue develops into cysts, scar tissue, and adhesions. This is scar tissue that causes the organs to bind together.
Most treatments for endometriosis aim to prevent ovulation. One example is taking birth control pills. When you are trying to get pregnant, you’ll stop taking these treatments.
The most common symptom of endometriosis is pain, including pelvic pain and strong cramping. But infertility can unfortunately also be a symptom and side effect of endometriosis.
An estimated one-third to one-half of women with endometriosis report difficulty getting pregnant.
How does endometriosis affect pregnancy?
Infertility due to endometriosis can be related to several causes. The first is if endometriosis affects the ovaries and/or fallopian tubes.
An egg must travel from the ovary, past the fallopian tube, and to the uterus for fertilization before implanting into the uterine lining. If a woman has endometriosis in her fallopian tube lining, the tissue may keep the egg from traveling to the uterus.
It’s also possible that endometriosis could damage a woman’s egg or a man’s sperm. While doctors don’t know exactly why this occurs, a theory is that endometriosis causes greater levels of inflammation in the body.
The body releases compounds that can damage or destroy a woman’s eggs or a man’s sperm. This can keep you from getting pregnant.
When to see your doctor
Some doctors may recommend seeing an infertility specialist before you even think about trying to become pregnant.
An infertility specialist may conduct blood tests, such as an anti-mullerian hormone (AMH) test. This test reflects your remaining egg supply. Another term for egg supply is “ovarian reserve.” Surgical endometriosis treatments can reduce your ovarian reserve, so you may want to consider this test when thinking about endometriosis treatments.
The only way to truly diagnose endometriosis is surgery to identify areas where the endometrium is present. But these surgeries can result in scarring that affects fertility.
Should you see a specialist for endometriosis?
If you’re thinking ahead to a time when you may wish to become pregnant, you may want to see your gynecologist or a fertility specialist when you’re initially thinking about endometriosis treatments. In some cases, a fertility specialist may recommend surgery to remove growths that are keeping a woman from getting pregnant.
But if you’ve had unprotected sex with your partner for six months and haven’t yet gotten pregnant, contact your doctor. If you haven’t been diagnosed with endometriosis, but are experiencing some of the symptoms of the condition, it’s important to share these with your doctor.
Your doctor may conduct testing, such as blood tests and a physical exam, to determine if there are any initial interventions they can suggest. Your doctor may also refer you to an infertility specialist.
Help for endometriosis-related infertility
If you’ve had difficulty getting pregnant due to endometriosis, you may wish to see an infertility specialist. This specialist can work with your doctor to determine the severity of your endometriosis and what could be contributing to your infertility.
Examples of treatments for endometriosis-related infertility include:
- Freezing your eggs: Endometriosis can affect your ovarian reserve, so some doctors may recommend preserving your eggs now in case you wish to become pregnant later. This option can be costly, and isn’t usually covered by insurance.
- Superovulation and intrauterine insemination (SO-IUI): This is an option for women who have normal fallopian tubes, mild endometriosis, and whose partner has good-quality sperm.
- A doctor will prescribe fertility medications such as Clomiphene. These medications help to produce two to three mature eggs. A doctor may also prescribe progestin injections.
- A woman will regularly undergo ultrasounds to ensure the eggs are at their most mature. When the eggs are ready, a doctor will insert a partner’s collected sperm.
- In vitro fertilization (IVF): This treatment involves extracting an egg from you and sperm from your partner. The egg is then fertilized outside the body and implanted into the uterus.
The success rates of IVF are 50 percent for women who don’t have endometriosis. But many women with endometriosis have successfully gotten pregnant thanks to IVF treatments. IVF is often recommended for women with moderate to severe endometriosis, or for women whose bodies haven’t responded to other treatments.
How to improve
your chances of conceiving with endometriosis
Currently, there’s no evidence that taking medicines can improve a woman’s chances of getting pregnant. But doctors may prescribe medications, such as progestins, as a means to increase the amount of pregnancy hormones in a woman’s body.
It’s also important to live as healthy a lifestyle as possible when you have endometriosis and are trying to get pregnant. This can reduce inflammation in your body and prepare it to help your baby grow and thrive throughout a healthy pregnancy.
Examples of steps you can take include:
- maintaining a healthy weight
- eating a healthy diet rich in fruits, vegetables, whole grains, and lean proteins
- engaging in moderate exercise on a daily basis (examples include walking, lifting weights, and participating in an aerobics class)
Keep in mind that age can be a factor for all women wishing to get pregnant. Higher fertility rates are associated with younger age. Women ages 35 and older are at greater risk for both infertility and miscarriage than younger women.
Outlook for endometriosis and fertility
Women with endometriosis have higher rates of:
- preterm delivery
- placenta complications
- cesarean deliveries
The good news is that there are many women every day with endometriosis who conceive and ultimately deliver a healthy baby. The key is to start discussing your conception options, sometimes even before you think about getting pregnant. When you’re trying to get pregnant, see your doctor if you haven’t conceived after six months.