Endometriosis and Fertility: The Facts

This article provides stacks of information and resources about endometriosis and its potential effects on fertility.

If you have endometriosis, you may have thought about how it could affect your chances of getting pregnant. There are many variables which will affect fertility including the severity of your condition and, as in people without endometriosis, your age, and it’s important to remember that everybody’s case is different.

Will endometriosis prevent me from conceiving naturally?

In most cases, no! It is generally believed that 60–70% of women with endometriosis are fertile. Furthermore, about half the women who have difficulties with getting pregnant do eventually conceive with or without treatment.

Endometriosis is categorised into four stages; 1 (minimal), 2 (mild), 3 (moderate) and 4 (severe). With higher severity endometriosis, scar tissue (adhesions) becomes more common throughout the reproductive system. It is not known exactly why endometriosis can affect fertility but there are several potential theories:

  • Adhesions can hinder fertility by trapping the egg, preventing it from getting successfully down the fallopian tube.
  • Greater levels of inflammation in the body can cause damage or even destroy the egg or sperm in the fertilisation process.

Undergoing surgery can help to remove adhesions and cysts which could be interfering with your fertility, but there are other ways that endometriosis can make it hard to conceive:

  • By unbalancing your body’s hormonal chemistry.
  • Causing your immune system to attack the embryo.
  • Affecting the tissue lining the uterus where the egg implants itself to grow.

Despite these potential obstacles, even with severe endometriosis, natural conception is still possible.

Talk to Your Doctor…

As a rule, it is a good idea to see your doctor is you haven’t been able to get pregnant after six months of trying. You doctor may order some tests to determine if there are any initial treatment or advice suitable to the situation, or they may refer you to an endometriosis or infertility specialist.

Endometriosis is a chronic condition that affects the reproductive organs, and in the NICE guidelines for endometriosis, the treatments themselves fork into two sections: ‘if fertility is a priority’ and ‘if fertility is not currently a priority’. Your doctor may recommend seeing an infertility specialist so that you can undergo necessary testing to provide you the with the best treatment plan for your endometriosis whilst doing everything possible to help with fertility. *Reference (See NICE Guidelines Algorithm Resource).

The only surefire way to diagnose endometriosis is via laparoscopic surgery to identify where areas of endometrium-like tissue are present. In some cases there is a possibility that this procedure can cause scarring that could potentially affect fertility, so it’s important to discuss options with your medical professionals. On the other hand, in some cases, a fertility specialist may recommend surgery to remove growths  and release adhesions that are keeping a woman from getting pregnant. So, as you can see, there are different approaches that can be taken depending on the needs and desires of individual patients. This is why frank and clear communication betters everyone’s chances for a positive outcome.

What Help is Available?

Often, management for endometriosis aims to prevent ovulation, for example taking birth control pills, so when you are trying to get pregnant, you’ll stop taking these treatments to restart ovulation.

There are several types of fertility treatment available but before starting a complete fertility evaluation is performed to work out the right kind of treatment for you:

Your doctor will likely perform hormone and other blood testing and take several factors into account, including:

  • The severity of the endometriosis
  • Current age,
  • How long you may have been trying to conceive
  • Whether you have conceived in the past
  • Whether there are other fertility factors, e.g. low sperm count or blocked tubes

After these factors have been assessed, your doctor and specialist can work together to determine what could be contributing to your infertility and initiate treatment accordingly.

Treatments for Endometriosis-Related Infertility

Endometriosis UK have a fantastic information pack on their website full of information about endometriosis and its effects on fertility and pregnancy. It contains detailed information about the treatment options and assisted reproductive techniques (ART) available for patients of stages with endometriosis and all combinations or partners wanting to get pregnant, including:

  • In vitro fertilisation (IVF)
  • Ovulation Induction (OI)
  • Super Ovulation and Intrauterine insemination (SO-IUI)
  • Gamete Intrafallopian tube Transfer (GIFT)
  • Egg Freezing
  • Egg or sperm donation
  • Surrogacy

Pregnancy and Endometriosis

Endometriosis UK tell us that:

‘endometriosis can cause delay in getting pregnant, but once you are pregnant, pregnancy is expected to be no different from normal. There are reports of women who had more pain in the first few months of pregnancy. In general, pain improves, but may return after giving birth as periods return.’


Age is a Factor

As we know, a person’s age is a main factor in influencing fertility. Fertility starts to decline quickly after the age of 38 and also increases the risk of miscarriage and chromosomal abnormalities in pregnancies.

Unfortunately, we are constantly reminded of the ‘cut-off line’ by medical professionals, – In fact, until recently, people who conceived after the age of 38 were considered to have ‘geriatric pregnancies’!! Thankfully, this atrocious term has now been done away with. Once you hit 38, 40, 42, or indeed any age whilst you’re still menstruating, it does not mean categorically that you’ll be unable to conceive. To give an example of a household name, comedian and presenter Jo Brand had her first child when she was 43 and her second at 45. In interviews she said although she wanted to be a mum she though it just wouldn’t happen for her. There are hundreds of women every year conceiving or choosing to have children later as modern life gradually affords more freedom of choice and less expectation of life trajectory for people who menstruate.  

Too many young women are given the impression that having endometriosis invariably means that they will become infertile. This is not the case, and most women with endometriosis do go on to have children.

References and Resources

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