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If you’ve been diagnosed with endometriosis and are thinking about having a baby, you probably have a lot of questions about the endometriosis-fertility relationship.
The first thing to know is this: Yes, you can get pregnant if you have endo.
ON THIS PAGE
- What is endometriosis?
- What are the chances of falling pregnant?
- Will IVF work if you have endo?
- Can endometriosis cause a miscarriage?
- Does endometriosis improve with pregnancy?
- Can infertility caused by endometriosis be treated?
While the condition can sometimes make conception more challenging, it doesn’t mean you’re infertile.
In fact, most people with endometriosis can conceive naturally and go on to build the families they’ve dreamed of.
In this post, we’ll answer some common questions about endometriosis and pregnancy.
What is Endometriosis?
Endometriosis occurs when tissue similar to the uterine lining grows outside the womb.
This tissue most often develops in areas around the pelvis, including the:
- Fallopian tubes
- Ovaries
- Bladder
- Rectum
- Peritoneum (the lining of the abdominal cavity)
Endometriosis affects around 10% of people during their reproductive years, with many of those affected over the age of 30.
The exact cause isn’t fully understood, but research suggests several possible factors, including:
- Retrograde menstruation (backflow of menstrual blood)
- Hormonal imbalances
- Genetic influences
Some people experience few or no symptoms, while others may have:
- Pelvic pain (often during periods or sex)
- Heavy or irregular periods
- Fatigue
- Bloating
- Bowel or bladder issues
Doctors can often suspect endometriosis based on symptoms and imaging, such as an ultrasound. However, the most reliable way to confirm the diagnosis is with a laparoscopy.
This keyhole surgery allows a specialist to insert a small camera into the abdomen to look for endometriosis tissue. A biopsy can then confirm the diagnosis.
When it comes to treatment, managing pain is often the first priority.
Depending on the individual, options may include hormonal contraception or over-the-counter pain relief.
Endo & Fertility: What Are the Chances of Falling Pregnant?
Recent studies1 suggest people with endometriosis have roughly a 2–10% chance of conceiving each month.
That might sound low, but it’s not dramatically different from the 15–20% monthly chance for people without the condition.
Doctors generally estimate that up to 70% of people with endometriosis remain fertile.
We still don’t fully understand why endometriosis affects fertility in some individuals but not others. In many cases, the condition’s severity plays a role.
For example, severe endometriosis can sometimes block the fallopian tubes, preventing sperm from reaching the egg or stopping a fertilised egg from travelling to the uterus.
Other factors also influence fertility, including:
- Age
- General health
- Your partner’s sperm count
For most couples, doctors recommend trying to conceive naturally first before moving to assisted reproductive treatments.
However, in vitro fertilisation (IVF) may be an option worth discussing with your GP.
Will IVF Work if You Have Endo?
In short, yes, IVF can work for people with endometriosis.
While IVF success rates may be slightly lower compared with people without the condition, it is still a well-established treatment for endometriosis-related infertility.
One reason IVF can be helpful is that it bypasses potential blockages in the fallopian tubes by placing the embryo directly into the uterus.
If your doctor recommends IVF, they may monitor you more closely during treatment. Some fertility medications can temporarily trigger endometriosis symptoms, but this is usually manageable.
Your doctor will also consider your overall health and your partner’s fertility when planning treatment.
Can Endometriosis Cause a Miscarriage?
Most people with endometriosis go on to have healthy pregnancies and full-term babies.
Miscarriage is a complex issue, and research findings are mixed.
Some studies2 suggest endometriosis doesn’t significantly increase miscarriage risk, while other research3 reports a moderately higher risk of pregnancy loss in people with the condition (around 35% compared to 22% in those without endometriosis).
It’s important to remember that miscarriage and pregnancy complications can happen for many reasons — with or without endometriosis.
Some potential pregnancy risks linked to endometriosis include:
Your GP or obstetrician can monitor your pregnancy and provide guidance if you have concerns.
Does Endometriosis Improve With Pregnancy?
Many people notice their endometriosis symptoms improve during pregnancy, although pregnancy itself doesn’t cure the condition.
For example, painful and heavy periods usually stop during pregnancy.
However, every case of endometriosis is different. Some people may still experience pelvic discomfort during pregnancy.
One possible reason is that the growing uterus puts pressure on surrounding pelvic structures, which can sometimes increase sensitivity in areas affected by endometriosis.
After childbirth, symptoms often return.
However, breastfeeding may delay their return, particularly if it postpones the restart of regular menstrual cycles.
Can Fertility Affected by Endometriosis Be Treated?
Yes, several treatments are available to improve fertility if you have endometriosis.
One common approach is laparoscopic surgery, which removes endometriosis tissue using small surgical instruments or laser techniques. The procedure is performed under general anaesthesia.
Although endometriosis can grow back over time (around 50% of cases within five years), surgery can improve the chances of conceiving.
Some forms of hormonal contraception can also help manage the condition.
For example, your doctor may recommend a Mirena intrauterine device, which releases progesterone to slow endometriosis progression.
You can remove the device when you’re ready to try for a baby.
After surgery, your doctor may assess fertility using the Endometriosis Fertility Index. This tool considers factors such as:
- Age
- Severity of endometriosis
- Previous pregnancy history
Assisted reproductive techniques can also help.
For example, intrauterine insemination (sometimes called artificial insemination) involves placing sperm directly into the uterus during ovulation to increase the chances of fertilisation.
Talk With Your GP
There are plenty of myths and “old wives’ tales” about endometriosis and pregnancy.
If you’re unsure what to believe, the best first step is to speak with your GP.
You may find that, like many people with endometriosis, you can conceive naturally and have a healthy pregnancy.
Many GPs at Doctors of South Melbourne have a special interest and extensive experience in women’s health and pregnancy care.
You can make an appointment online or call us on (03) 8579 6838.
References:
1Fadhlaoui A, Bouquet de la Jolinière J, Feki A. Endometriosis and infertility: how and when to treat?. Front Surg. 2014;1:24. Published 2014 Jul 2. doi:10.3389/fsurg.2014.00024
2 Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016 Jan-Feb;22(1):70-103. doi: 10.1093/humupd/dmv045. Epub 2015 Oct 7. Review. PMID: 26450609
3 Kohl Schwartz, Alexandra Sabrina et al. Endometriosis, especially mild disease: a risk factor for miscarriages. Fertility and Sterility, Volume 108, Issue 5, 806 – 814.e2
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