women smiling at pregnancy test

Endometriosis and Pregnancy: Fertility, Risks, IVF & More – Dr Judith Kirwood

Yes, you can get pregnant with endometriosis.

Having the condition can occasionally make it harder to have a baby. However, an endometriosis diagnosis certainly doesn’t mean you’re infertile. In fact, the majority of women can conceive naturally and grow their family.

Below we’ll answer the following questions:

What is endometriosis?

Endometriosis is a condition where the tissue lining your uterus grows outside of your womb. The often painful ailment typically develops around one or more areas of your pelvic region, including your:

  • fallopian tubes
  • bladder
  • ovaries
  • rectum
  • peritoneum (lining of your abdominal cavity)

We estimate the condition directly impacts around 10% of women during their ‘fertile’ years, many aged over 30 years old. Exact causes remain a mystery, yet there’s evidence retrograde menstruation, genetics and hormone imbalances play a role.

Though some women don’t experience symptoms, others are commonly inflicted by:

  • pelvic pain – often during sex and menstruation
  • heavy and irregular periods
  • fatigue
  • bloating
  • bowel and bladder issues

Having a laparoscopy is the best method of diagnosis. This is where a light and camera are inserted into the abdomen using keyhole surgery. A biopsy of the affected area can confirm the presence of endometriosis.

When treating the condition, pain management usually comes first. Depending on the individual, oral contraception can often help, as too can over-the-counter pain medication.

Can you get pregnant with endometriosis?

Recent studies1 suggest there’s a 2-10% chance of women with endometriosis getting pregnant each month. It doesn’t sound like much, but compared with a 15-20% chance for women without the condition, the relative odds are pretty good.

Doctors commonly accept that up to 70% of people living with endometriosis are fertile.

We don’t exactly know why endometriosis causes infertility in some women. Many doctors believe the severity of the condition impacts fertility. Severe cases can cause your fallopian tubes to be blocked, preventing sperm from reaching the egg or restricting a fertile egg moving into your uterus.

Other factors such as your age and your partner’s sperm count also come into play when we’re talking about fertility and endometriosis.

IVF is an option your GP may discuss with you. The rates of conception using this method are only slightly lower than for those without diagnosed endometriosis. Fertility experts recommend women try to conceive naturally before trying IVF. As part of the IVF process, it’s essential to take into account your partner’s fertility and your overall health.

Can endometriosis cause a miscarriage?

The majority of pregnant women with endometriosis will carry their baby to full-term.

Miscarriage is an incredibly complicated area of which we still have much to learn. Some research2 tells us that endometriosis presents little risk throughout pregnancy. Other studies3 indicate that women with the condition have a higher chance of pregnancy loss (35%) than women without (22%).

Miscarriage and pregnancy complications can occur for any number of reasons whether or not you have endometriosis.

Other endometriosis-related risk factors during pregnancy include:

Does endometriosis improve with pregnancy?

Symptoms of endometriosis often improve when you’re pregnant. Nevertheless, pregnancy certainly doesn’t cure the condition.

Obviously, painful and heavy periods will stop bothering you for around nine months.

It’s important to note that every woman’s body and every case of endometriosis is unique. Several people find their symptoms get worse when pregnant. One reason for this could be an expanding uterus putting additional pressure on other parts of their pelvic region, increasing the sensitivity of regional endometriosis.

Endometriosis typically comes back after childbirth. Breastfeeding has been known to delay symptoms returning. This is especially the case for mothers breastfeeding their baby regularly enough to delay menstruation starting up again.

Can infertility caused by endometriosis be treated?

Yes, there are various treatments available to improve fertility if you have endometriosis.

Laparoscopic surgery is a rather effective method used to remove endometriosis tissue. The tissue is either cut away or ‘lasered’ off. You’ll be under general anaesthetic during the procedure, so you won’t feel a thing.

Though tissue can grow back over five years (in an estimated 50% of cases) the chances of falling pregnant after a laparoscopy improve.

Your surgeon may assess your chances of conceiving using the endometriosis fertility index (EFI) following surgery. The EFI looks at aspects such as your age, severity of your condition and history of pregnancy.

Like IVF, intrauterine insemination (IUI) is an assisted reproductive technique. It has proven somewhat successful in helping people with endometriosis fall pregnant. Also known as artificial insemination, IUI involves physically inserting semen into your uterus via your cervix during ovulation.

Talk with your GP

You’ll no doubt hear a lot of ‘old wives’ tales’ about endometriosis and how it affects, and is affected by, pregnancy. I recommend taking all unqualified advice with a grain of salt and talking with your GP instead.

There’s every chance you’re like the vast majority of women who can have a baby without any problems at all.

Check out Endo Wise for first-hand accounts of eight women living with endometriosis. It’s from Jean Hailes, a not-for-profit leader in women’s health.

Dr Judith Kirwood is a senior GP at Doctors of South Melbourne. She has extensive experience in women’s health and pregnancy planning.

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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