Endometriosis is a condition where the tissue that makes up the uterine lining grows outside of the uterus. About 10 percent of women will be diagnosed with this condition, usually in the third or fourth decades of their lives. The tissue is most commonly found growing in the areas close to the uterus, including the fallopian tubes, ovaries, and peritoneum, but it can also be found in other places, including the intestines, bladder, and rectum. This can cause pain and adhesions, meaning that the body creates scar tissue from the damage done.
Can endometriosis cause infertility?
Not all women who have endometriosis deal with infertility. In fact, some women with endometriosis don’t even have symptoms. However, about 30 to 50 percent of women who deal with infertility also have some form of endometriosis. Endometriosis may or may not be to their main cause of infertility, but either way, it can certainly interfere with getting pregnant.
How does endometriosis cause infertility?
The scar tissue or adhesions from endometriosis can cause issues with infertility in a number of ways. Sometimes endometriosis can block the sperm and egg from reaching one another or otherwise disrupt their movement or even their quality. In some more severe cases, the fallopian tubes might actually be blocked by the endometrial tissue, preventing pregnancy.
There is also the issue of pain from endometriosis. It can be difficult to conceive naturally when you are in a lot of pain or if you're experiencing heavy bleeding.
How do you treat endometriosis if your goal is to get pregnant?
The treatment for endometriosis depends on the symptoms, how severe it is, and whether you want to get pregnant. Medications are typically the first line of defense for endometriosis; however, these are mainly to deal with pain and not fertility issues. Surgery is also an option. If you are trying to conceive, make sure you speak about the best way to treat endometriosis with your doctor.
There are a couple different types of medications that are used to treat endometriosis. One type is for pain relief — typically NSAIDs, like ibuprofen. These can reduce the inflammation caused by the endometriosis and therefore relieve some pain. The other type of medication used is typically hormonal. This often includes the use of birth control pills, which, if you’re trying to get pregnant, isn’t ideal. One of the risks of medicinal treatment is that it may actually delay surgical treatment, which is better suited for the later stages of endometriosis.
Surgery can also potentially increase your chances of becoming pregnant, but not for mild endometriosis or cases without symptoms. That said, multiple or additional surgeries don’t always mean improved chances of pregnancy.
One way to surgically treat endometriosis is to remove the growths of the disease. This is known as excisional surgery. You can also remove the growths by destroying them with heat or another method. This is known as ablative surgery. Either type of surgery can help reduce the pain, but an excisional surgery is more likely to improve your chances of getting pregnant without additional help.
Many women find that the relief from surgery is temporary, so it is often recommended that you begin the process of trying to get pregnant as soon as reasonable after the surgery. The benefits to your fertility may only last for about two years.
For those not choosing to conceive, the other surgical solution is the removal of the uterus and ovaries in a hysterectomy. Obviously, having a hysterectomy is not the ideal solution if you intend to get pregnant, and it has the potential to cause other issues as well.
Which fertility treatments should I use beyond treatment for endometriosis?
Endometriosis treatments are different from fertility treatments. Often the fertility treatments can be used in tandem with the endometriosis treatments, or, in cases of mild endometriosis, you may only need some forms of basic fertility treatments. These could include medications to assist with ovulation, intrauterine insemination, and other options.
If you are over 35 years of age, and/or have stage III or IV endometriosis, surgery is your best bet. However, if you don’t get pregnant within a few cycles, it may be beneficial to try methods like in vitro fertilization (IVF). This is because, in addition to the endometriosis, you will be battling a declining fertility rate due to age.
Pregnancy outcomes after endometriosis
There are some things you should keep in mind about getting pregnant with endometriosis. First, the good news: There does not appear to be an increased risk of stillbirth associated with pregnancy and endometriosis. The same is true of the risk of having a small-for-gestational-age baby. However, there is an increased risk of the following:
- Preterm labor
- Cesarean birth
- Placental complications
- Postpartum bleeding
Unfortunately, we don’t know if these risks are due to endometriosis, the resulting infertility, or even perhaps the fertility treatments used.
The bottom line
There are many variables to consider when trying to get pregnant with endometriosis. Some women get pregnant and don’t get diagnosed with endometriosis until after they’ve had babies. Other women will have surgery and wind up conceiving with no additional issues, while others need surgery and fertility support — sometimes even IVF. Your doctor can help you figure out how to best manage your fertility, pain, and endometriosis while hopefully meeting all of your personal family-related goals.