Endometriosis is a condition in which uterine lining grows outside of the uterus. Endometriosis is linked to infertility, but it doesn't always mean you can't get pregnant.
Endometriosis is a condition in which uterine lining grows outside of the uterus. Endometriosis is linked to infertility, but it doesn't always mean you can't get pregnant.

Endometriosis can make getting pregnant more difficult. However, 7 in 10 women with mild to moderate endometriosis can still get pregnant without treatment. Endometriosis is a condition in which small pieces of tissue that are similar to the inner lining of your womb grow outside of the womb. 

This tissue can grow on: 

  • Ovaries
  • Fallopian tubes
  • Bowels
  • Bladder
  • The lining of your abdomen

Some women have no symptoms; others have severe symptoms. It’s a common condition that often goes untreated. Endometriosis is linked to infertility, but it doesn’t always mean you can’t get pregnant

Stages of endometriosis

The severity of your stage of endometriosis and the severity of your symptoms aren’t necessarily related. You may not even know you have the condition until your doctor evaluates your reproductive system if you’re having a difficult time getting pregnant. 

Symptoms vary from person to person, but the most common symptoms are: 

  • Painful, heavy, or irregular periods
  • Pain in your lower abdomen, pelvis, or lower back around and throughout your period
  • Ongoing pelvic pain lasting six months or longer
  • Pain during or after sex
  • Difficulty getting pregnant
  • Painful bowel movements and emptying of your bladder

When your doctor evaluates you for endometriosis, they’ll tell you the stage your condition has reached. Endometriosis is not cancer, but it is classified into four stages. 

Stage I

There are a few tiny patches of endometriosis growing internally in this stage. At this stage, no scar tissue is seen. 

Stage II

At this stage, there’s clear but limited evidence of the condition. There are more patches of endometriosis, but less than two inches of the abdomen is affected. There’s still no scar tissue seen. 

Stage III

This stage is considered a moderate case of the disease. More endometriosis is seen in the abdomen, creating deeper pockets of endometrial fluid in your ovaries. Your doctor may see scar tissue in and on your tubes or ovaries.

Stage IV

There will be a lot of endometriosis patches in this stage, with a possibility of large endometriotic cysts on your ovaries. There could also be scar tissue between your uterus and rectum and around your ovaries or fallopian tubes. 

Fertility with endometriosis

There’s no precise understanding of the link between infertility and endometriosis. But having advanced endometriosis can make it harder to conceive naturally though it’s not impossible. If you’re experiencing difficulty getting pregnant, you should ask your doctor for a referral to a gynecologist or fertility specialist.

Endometriosis affects roughly 10% to 15% of women of reproductive age. IVF examinations have shown that advanced endometriosis in women causes a low ovarian reserve, low embryo quality, and affects the implantation process.  

Fertility treatment options

Some studies have shown that fertility may improve stage I or II endometriosis lesions are surgically removed. Other studies show this doesn’t improve fertility. Treatment plans typically vary depending on what stage of endometriosis you’re in. 

Stage I and II endometriosis treatment. At this stage, your doctor may recommend a fertility drug called clomiphene citrate. You’ll take this for five days starting after the beginning of your period. Once your egg is released during ovulation, the doctor will place sperm into your uterus. The likelihood of you getting pregnant with one treatment of clomiphene/IUI is about 10% if you’re under the age of 40.

Stage III-IV endometriosis treatment. For severe endometriosis, your doctor will recommend removing scar tissue and any cysts affecting your reproductive system. They’ll make sure your fallopian tubes aren’t blocked by extra tissue. If you don’t get pregnant within six to 12 months, they’ll recommend another type of treatment.

In-vitro fertilization (IVF). This treatment is recommended by your doctor based on age and hormone levels in your body. You’ll have to take small injections of fertility medications. Once your eggs grow to a specific size, your medical team will remove them. They will then combine the egg with sperm in a lab. 

In most cases, your eggs will be fertilized and go on to become embryos. Once the embryos are grown, they’ll be secured in your uterus to complete gestation. Your likelihood of pregnancy from this treatment ranges from 50% or higher for women in their 20’s and about 10% for women in their 40’s. 

If you have trouble getting pregnant after six or seven months of trying naturally, you can talk to an infertility specialist to determine the next steps. This is compared to the one-year recommended timeframe for women without endometriosis. 

Pregnancy with endometriosis

Once you’ve become pregnant, you may feel as though you should be extra cautious during the pregnancy. However, in most cases, women with endometriosis will have a relatively average pregnancy. You don’t necessarily need extra monitoring, but you can talk about your concerns and feelings with your doctor. 

Symptoms during pregnancy

In some cases, endometriosis symptoms have been seen to improve during pregnancy. However, the condition almost always comes back after birth when you get your period again. Toward the end of your pregnancy, your doctor may watch for high blood pressure and some bleeding.

Complications and risks

Endometriosis complications and risks during pregnancy are relatively low. There is a risk for low-lying placenta when the placenta attaches at a low point in your womb, close to or even overlapping the cervix. Another risk is ectopic pregnancy, but your doctor will consider this during ultrasounds.

Endometriosis alters your body’s physiology in ways that can affect the stages of pregnancy and childbirth. Inflammation and progesterone levels during implantation can also be affected by endometriosis. 

Endometriosis after childbirth

At the end of your pregnancy and after delivery, you may notice an improvement in your endometriosis symptoms. Higher progesterone levels in your body cause this. Researchers believe progesterone slows the growth and development of endometriosis lesions. 

Unfortunately, relief from endometriosis after childbirth only lasts for a few months to a couple of years. Eventually, the endometriosis grows again. 

When to talk to your doctor

If you’re concerned about endometriosis and fertility, you should talk with your doctor soon. A proactive approach to treatment options and management can increase your chances of getting pregnant. Your doctor will talk through treatment options with you and help you move forward in your pregnancy journey. 

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Medically Reviewed on 3/28/2022
References
SOURCES:

American Pregnancy Association: "Endometriosis."

Brigham and Women's Hospital: "Endometriosis and Fertility."

Jefferson: "Endometriosis Increases Risk of Complications during Pregnancy & Delivery."

Obstetrics and Gynecology Clinics of North America: "Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility."

Penn Medicine: "Endometriosis and Fertility: Three Reasons For Women To Have Hope."

Pregnancy, Birth and Baby: "How endometriosis affects pregnancy."

Tommy's: "How does endometriosis affect fertility.”