Endometriosis and Pregnancy: Risks, Fertility, IVF & Treatments

by | Aug 21, 2019 | Pregnancy, Women's Health | 0 comments

🕓 Reading time: 5 minutes

Yes, you can get pregnant with endometriosis.

Having the condition can occasionally make it harder to have a baby. However, an endo diagnosis certainly doesn’t mean you’re infertile.

In fact, the majority of people can conceive naturally and grow their lovely families.


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What is Endometriosis?

Endometriosis is a condition where the tissue lining your uterus grows outside your womb.

The often painful ailment typically develops around one or more areas of your pelvic region, including your:

  • fallopian tubes;
  • bladder;
  • ovaries;
  • rectum, and
  • peritoneum (lining of your abdominal cavity).

We estimate the condition directly impacts around 10% of people during their ‘fertile’ years, many of whom are over 30 years old.

The exact causes remain a mystery, yet there’s evidence retrograde menstruation, genetics, and hormone imbalances play a role.

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

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

The presence of symptoms and getting an ultrasound can assist in making a likely diagnosis of endometriosis, yet having a laparoscopy is the best method to 100% confirm.

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, some forms of contraception can often help, as can over-the-counter pain medication.

What are the Chances of Falling Pregnant?

Recent studies1 suggest a 2-10% chance of people with endometriosis falling pregnant each month.

pregnant ultrasound

It doesn’t sound like much, but the relative odds are pretty good compared to a 15-20% chance for people without the condition.

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 people, and 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 from 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.

Fertility experts recommend people try to conceive naturally before trying assisted reproduction methods.

In saying this, in vitro fertilization (IVF) is an option your GP can discuss with you.

Will IVF Work if You Have Endo?

In short, yes.

Though IVF conception rates are slightly lower than those without endometriosis, the procedure has success in treating endo-related infertility.

Endometriosis commonly impacts fertility by blocking the movement of sperm through your fallopian tube. IVF can bypass this problem and place the embryo within the uterus.

If together we feel IVF is an option, we’ll need to look at monitoring you a bit closer than usual. Some fertility medications have been known to trigger endo symptoms, though usually temporarily. 

As part of the IVF process, it’s essential to also 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 shows that endometriosis presents little risk throughout pregnancy.

Other studies3 indicate those with the condition have a higher chance of pregnancy loss (35%) than women without (22%).

Miscarriage and pregnancy complications can occur for many 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.

pregnant couple

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

It’s important to note that everyone’s body and every case of endometriosis is unique. Some people find endometriosis pain during pregnancy gets worse.

One reason for this could be an expanding uterus putting additional pressure on other parts of the pelvic region, increasing the sensitivity of regional endometriosis.

Endometriosis typically comes back after childbirth.

Breastfeeding has been known to delay symptoms returning, especially for mothers breastfeeding their baby regularly enough to delay menstruation starting up again.

Can Infertility Caused by Endometriosis Be Treated?

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

Laparoscopic surgery is a rather effective method for removing 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.

There is also a role for some types of contraception to reduce the effects of endometriosis. For example, your doctor may recommend a Mirena intrauterine device.

This device slowly releases progesterone to reduce the spread of endometriosis. It can then be removed when you are ready to start a family.

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.

cute baby blue eyes

Like IVF, intrauterine insemination (IUI) is an assisted reproductive technique, and 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.

You may be like the vast majority of people who can have a baby without any problems.


Dr Caroline Roth blogs

Dr Caroline Roth is a local GP at Doctors of South Melbourne.

She’s a qualified GP obstetrician with special interests in pregnancy care, women’s health, and kid’s health.

You can make an appointment online with Caroline 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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