Does endometriosis affect my chance of getting pregnant?

Does endometriosis affect my chance of getting pregnant_

If you have endometriosis, one of the first questions you may ask on being diagnosed is ‘Can I still have children?’. The condition, which is known to affect fertility, means that tissue similar to the lining of the womb, which sheds each month as a period, is found in places outside of the uterus. Unlike within the womb, where the blood can exit as menstruation, when the tissue is found in other parts of the body (around the ovaries, near the bowel or bladder, or even in the lungs) it cannot escape.

Instead, it causes an ongoing inflammatory reaction in that area of the body. We don’t know exactly how many women have endometriosis as thankfully not all those with the condition will have symptoms, but the estimate is between 2 and 10% of women. In women who are having fertility problems, however, this number rises to almost 50%.1

Symptoms and diagnosis

While not everyone with the condition will display symptoms, those who do may experience anything from mild to debilitating period pain, pain during intercourse, pain on opening their bowels or urination, and pelvic pain, depending on where the tissue deposits are. Women may also form ‘chocolate’ cysts (collections of old bleeding tissue around the ovaries), and may have associated irritable bowel symptoms.2

For the majority of women this pain is cyclical, peaking during menstruation and resolving once your period finishes. The severity of pain does not seem to tally directly with the amount of endometriosis found. To diagnose the condition, the doctor will listen to your medical history and will examine you via ultrasound or MRI scan. It can only be diagnosed directly via keyhole surgery, where the lesions can be seen and sent to the lab to confirm that it is endometrial tissue that has been found outside the womb.3

Endometriosis and fertility

Statistics show that the majority of couples (84%) having unprotected sex 2-3 times per week for one year will become pregnant. This figure increases to over 92% with couples that have been trying for two years.4 A diagnosis of infertility is made when a couple have been having unprotected sex 2-3 times a week for one year and have not conceived spontaneously. There are many different reasons for why this may be, ranging from age, genetics, infections, and the personal medical histories of both partners. Endometriosis is only one of a multitude of potential causes, but one that if found may be amenable to surgery to help your chances of conceiving either naturally or through IVF.

Chronic inflammation puts your body’s natural defence system into overdrive, which can negatively affect both the egg and the sperm.

How endometriosis happens and how it affects fertility are still the subject of much research, and there are no concrete answers as of yet, although around 30-50% of women with endometriosis are infertile.5 At the moment doctors believe that endometriosis affects fertility through the presence of inflammation. Chronic inflammation puts your body’s natural defence system into overdrive, which can negatively affect both the egg and the sperm.

In a similar way, the changes in a woman’s immune system that allowed the endometrium-like tissue to exist in other parts of the body may also be implicated in the overall big picture of why some women find it more difficult to become pregnant with endometriosis.

On top of that, the adhesions of endometrial tissue can become an issue. Normally, the organs in your pelvis move about quite freely. Your Fallopian tubes in particular are soft tubes that waft the fertilised egg into the uterus. However, when there is a lot of scarring due to the chronic inflammation, the organs can become stuck together and stay in a fixed position. This means the organs can’t function as they normally would, affecting your ability to get pregnant.

As nobody knows why some women develop endometriosis, as of yet there is no way to prevent it from occurring, and no studies thus far have proven anything to be effective.6 Sometimes, women won’t even know they have the condition until they are investigated because of difficulties getting pregnant.

How can I improve my chances of getting pregnant if I have endometriosis?

Endometriosis is a disease activated by hormones. If you don’t bleed with a monthly period, for example by taking medicines that mask your natural cycle or block the effects of oestrogen, then the disease dies down, albeit temporarily. Managing endometriosis largely depends on what is of most concern to you – either the management of pain, or getting pregnant. This is because many of the medical treatments offered are similar to contraceptives. Treatment ranges from simple painkillers, to hormones like the combined oral contraceptive pill, stronger hormones that induce a temporary menopause, and surgery.

Surgery has been proven to help women with moderate to severe endometriosis who are trying to get pregnant.

Surgery aims to break apart any adhesions causing your organs to stick together, and also locates as many of these tiny endometrium-like tissue deposits as can be found and either burns or removes them to reduce the amount of inflammation that occurs when they bleed each month. If you have cysts caused by endometriosis, your fertility specialist or gynaecologist will discuss the best way forward to manage these surgically. This takes into account your age, the size of the cysts, how easy or difficult a surgery might be, and whether removing the cysts or draining them would cause the least damage to your ovaries (and thus preserve your eggs for getting pregnant).7 Surgery has been proven to help women with moderate to severe endometriosis who are trying to get pregnant, but it is not without risk, and the benefits of surgery need to be timed in relation to your fertility needs.

If you are trying to conceive and think you may have endometriosis your doctor will investigate you and your partner fully to determine the best course of action. Every approach is unique to the challenges that you and your partner face, as difficulty getting pregnant is due to a variety of different factors, and different treatments are suited to different situations. However, a diagnosis of endometriosis isn’t necessarily a diagnosis of infertility, and, as detailed above, there are ways of improving your fertility if you do have the condition.

Featured image is of a woman’s hands holding a pregnancy test. Only her hands and knees are in the frame. The image is in the style of a collage, and the woman’s hands and knees are surrounding by a symmetrical pattern made up of short, squiggly lines

Last updated February 2019
Next update due 2021

Author’s disclaimer: This content is designed to provide general information and is not a substitute for medical advice. Medical opinion, practice and routine may vary from country to country and may change from time to time. The author is not liable for the results of misuse or inappropriate application of the information. If you are an individual who chooses to access this information, you should not rely on the information as professional medical advice or use it to replace any relationship with your doctor or other qualified healthcare or social care professional. For medical concerns, including decisions about medications and other treatments, individuals should always consult their doctor or, in serious cases, seek immediate assistance from emergency personnel. Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. Individuals with specific queries or concerns should seek appropriately qualified medical advice. Clinicians must use their own judgement when interpreting this information and deciding how best to apply it to the treatment of patients.

References

  1. G. A. Dunselman et al., ‘ESHRE Guideline: Management of women with endometriosis’, Hum Reprod., Vol. 29, No. 3, 2014, 400-12, (accessed 2 February 2019).
  2. Ibid.
  3. Ibid.
  4. RCOG, ‘Assessment and Treatment for Women with Fertility Problems’, Nice Clinical Guidelines No. 156’, 2013, (accessed 2 February 2019).
  5. C. Bulletti et al., ‘Endometriosis and infertility’, J Assist Reprod Genet., Vol. 27, No. 8, 2010, 441-447, (accessed 2 February 2019).
  6. G. A. Dunselman et al., ‘ESHRE Guideline: Management of women with endometriosis’, Hum Reprod., Vol. 29, No. 3, 2014, 400-12, (accessed 2 February 2019).
  7. K. Jayaprakasan et al., ‘The Effect of Surgery for Endometriomas on Fertility’, RJOG, Vol. 125, Iss. 6, 2018, e19-e28, (accessed 2 February 2019).

Dr. Natasha Abdul Aziz

Natasha is senior clinical fellow in Obstetrics & Gynaecology with the Chelsea & Westminster NHS foundation trust. She was previously a clinical research fellow at the University of Oxford and national women’s health lead for the Muslim Doctors Association of the UK. Her special interests include the use of digital healthcare solutions to help vulnerable populations of women, volunteer work with refugees, and chasing that last sliver of sun on her balcony after work.

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