How Endometriosis Can Affect Fertility and Pregnancy

Any diagnosis of a condition affecting the reproductive system will leave people with questions about their fertility, and endometriosis is no different.

The condition, experienced by as many as 10 percent of women, affects the uterus and surrounding tissues and can therefore impact fertility. However, endometriosis does not automatically lead to infertility, and there are treatment options that can help. Working closely with medical professionals to monitor the condition is essential to treating and managing this condition, especially for people who at some point want to conceive.

What is endometriosis?

When someone has endometriosis, the tissue normally found inside the uterus—the endometrium—grows outside the uterus as well, usually on the ovaries, bowels and other organs in the pelvic area.

During the menstrual cycle, this tissue continues to thicken, break down and shed, as it would in the uterus. Because it is located outside the uterus, however, the broken-down tissue becomes trapped in the pelvis. There, it can cause irritation, scar tissue formation, painful or heavy periods, and potentially, infertility.

Symptoms and treatment

Endometriosis has a number of common symptoms, but they can vary greatly from person to person. Symptoms may include:

• Pelvic pain, including in the lower abdomen and back, which usually occurs in the weeks around menstruation
• Heavy menstrual bleeding or bleeding outside of periods
• Infertility
• Pain during or after sex
• Discomfort during bowel movements

Each case of endometriosis is different: Someone with advanced endometriosis can have very few symptoms, while someone with a milder form can experience significant symptoms, and vice versa.

Regular gynecological exams can help detect endometriosis sooner, but if you experience several of these symptoms, it is important to talk to a gynecologist and schedule tests straight away.

Treatment for endometriosis can involve both pain management and surgical removal of the extra tissue. Doctors may prescribe medications or hormonal therapy to relieve pain; the latter will also help slow the growth of endometrial tissue. Laparoscopic surgeries to remove the trapped tissue can also help with pain management and increase the chances of conception.

The last resort in treatment for endometriosis is the complete removal of the uterus and sometimes the ovaries. For this reason, it is essential to talk with your doctor about your best options, especially if you are considering becoming pregnant in the future.

Endometriosis, conception and pregnancy

Infertility can be a symptom of endometriosis but is not a given, occurring in only 30 to 50 percent of cases. It's not entirely clear how endometriosis affects fertility, but in some cases, the fallopian tubes can become blocked by scar tissue, preventing eggs from reaching the uterus. Inflammation caused by endometriosis can also prevent the fertilization process.

In order to conceive while suffering from endometriosis, some treatments may be necessary. Laparoscopic surgery to remove the tissue can improve the chances of conception, especially in the first few months following surgery. This technique can be paired with fertility treatments such as in vitro fertilization (IVF), where fertilization occurs in a lab and fertilized eggs are implanted in the uterus, or intrauterine insemination (IUI), where a sperm cell is injected directly into the uterus for implantation. However, many women with endometriosis are able to conceive without the help of fertility treatments.

After conception, endometriosis can affect pregnancy and vice versa. In fact, for many women, pregnancy can help improve symptoms of endometriosis because they are not having periods. The hormone progesterone, which is released during pregnancy, is thought to even shrink tissue growth, and its synthetic form is a standard treatment for endometriosis.

Some women, however, may instead find that pregnancy exacerbates symptoms, often due to the stretching uterus putting more traction on areas of inflamed or scarred tissue. Pregnancy and breastfeeding after delivery most often improve endometriosis.

Women with endometriosis are at higher risk of certain pregnancy complications, including preterm delivery, preeclampsia, placenta complications and cesarean deliveries, but many women carry healthy babies to full term.

It's important to note that these complications of pregnancy do not happen in every endometriosis patient, especially those women who had it under control with treatment.

Finding solutions and support

If you or someone you love has recently been diagnosed with endometriosis, you probably have many questions. It's important to remember that having endometriosis does not definitively cause infertility, and that there are many treatment options available to both manage the condition and conceive. If you are having difficulties dealing with a diagnosis, know that support is available through in-person and online support groups.

Not everyone with endometriosis has the same level of severity, symptoms or difficulty starting a family—each person has their own journey. If you plan to start a family, be sure to talk with your doctor to determine the best plan of action.