Roughly 10 percent of reproductive-age women—that's 190 million globally—suffer from endometriosis, a disorder in which tissue that normally lines the uterus grows outside the uterus.
This chronic inflammatory disease includes a wide variety of debilitating symptoms, such as extreme menstrual cramping, back pain, pain during sex and, for some women, difficulty becoming pregnant.
While endometriosis can significantly impact your ability to become pregnant, it doesn't affect all women the same way.
It's estimated that roughly 30 percent to 50 percent of women suffering from endometriosis are infertile, and the connection between endometriosis and infertility is complicated.
"Endometriosis is highly correlated with infertility," confirmed Kecia Gaither, M.D., an OB-GYN at NYC Health + Hospitals/Lincoln in the Bronx in New York City. "While the specific underlying etiology for such is unclear, several factors may be involved."
These factors include inflammation, hormonal imbalance and significant scarring of pelvic reproductive organs.
"Pain is caused by the inflammation of the endometriosis implant," said Tara Scott, M.D., medical director of integrative medicine at Summa Health System headquartered in Akron, Ohio.
It's this inflammatory response to endometriosis that can make it more difficult to become pregnant.
"Inflammation from cytokines and prostaglandin around the implants, throughout the pelvic cavity and within the uterus play a role in infertility," Gaither added.
Another culprit might be hormonal imbalance, which is also linked to endometriosis.
"Many women have hormonal imbalances involving ovarian, adrenal and thyroid hormones, all of which are important in fertility," Gaither explained.
Endometriosis causes the production of too much estrogen and too little progesterone in women. While estrogen is important to fertility, too much estradiol—an estrogen hormone responsible for uterine tissue growth—can cause inflammation, which can make it more difficult to become pregnant.
Lastly, scarring caused by endometriosis might impact pregnancy. Endometriosis may lead to swelling and can cause adhesions and scar tissues, Scott said. Women with severe endometriosis can be left with scar tissue around their reproductive organs, which can block the fallopian tubes, making it more challenging to become pregnant.
The American Society for Reproductive Medicine (ASRM) has divided endometriosis into four stages based on the number of lesions and depth of infiltration. Stage I is considered minimal and stage IV is severe.
"The higher the degree or stage of endometriosis, the higher the likelihood of infertility," Gaither said. However, the type or severity of endometriosis does not always correlate with the symptoms experienced by an individual.
If you're diagnosed with a higher stage of endometriosis, it doesn't necessarily mean you won't be able to have children, but it does mean you should talk about your fertility with your gynecologist.
While some women may be able to increase their chances of fertility through surgery and lifestyle changes, those with more severe cases of endometriosis might not. This is why it's recommended you talk to your doctor so they can identify the stage of your endometriosis and whether your fertility is impacted.
Treating endometriosis may be able to reverse infertility or improve the chance of pregnancy in some women. The standard surgical treatment for endometriosis is laparoscopy. Laparoscopic surgery can also identify your stage of endometriosis, leading to a more tailored treatment plan for your unique needs.
A surgeon removes scar tissue and lesions during a laparoscopy, and this removal can help increase the chance of conceiving. In fact, studies indicate this procedure could double your chances of pregnancy if your disease is mild, and still moderately improve your chances if your disease is moderate to severe.
Other options for treating endometriosis symptoms, such as inflammation, include regular exercise, an anti-inflammatory diet high in omega-3 fats from foods including eggs and oils, and antioxidants from berries and leafy greens.
In vitro fertilization (IVF) could also help if you have a mild stage of endometriosis, however, studies have found mixed results on the subject, and more research is needed. Talking through all of your options with your OB-GYN is imperative, so you can understand the success rates, symptoms and risks up front.
If you have endometriosis and do become pregnant, extra precautions may be needed to make sure both you and your baby have a healthy pregnancy, labor and delivery. Research indicates that women with endometriosis are at higher risk for several pregnancy complications.
Women with endometriosis have a statistically significantly higher risk of preterm birth, miscarriage, placenta previa, birthing an underweight baby and cesarean delivery, according to a 2017 meta-analysis of almost 2 million women published in the journal Fertility and Sterility. The authors noted, however, their research did not indicate a higher risk for gestational hypertension and preeclampsia.
"It's important that women with a history of endometriosis, and obstetricians caring for them, are aware of this association between prior endometriosis and higher risks of [complications]," said Vincenzo Berghella, M.D., in a news release from Thomas Jefferson University in Philadelphia.
"These pregnancies deserve closer monitoring for these complications," continued Berghella, who is one of the authors of the meta-analysis, and professor of gynecology and director of maternal fetal medicine in the obstetrics and gynecology department at the Sidney Kimmel Medical College at Thomas Jefferson University.
Gaither added that if a C-section is warranted, there may be adhesive disease from the endometriosis present, potentially increasing the difficulty of delivery.
Considering these potential complications, it's important to find an OB-GYN you trust to help guide you through both your fertility and pregnancy journey.
