If you have endometriosis, you know that the condition can be stressful all on its own. But once you start thinking about getting pregnant, it’s completely normal to wonder how endometriosis might affect your ability to conceive — not to mention whether you or your baby will be at risk once you do get pregnant.
Having the facts just might help ease some of your concerns. Here’s everything you need to know about conceiving with endometriosis, plus how it could affect your pregnancy.
What is endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus grows in places where it shouldn’t — like the ovaries or fallopian tubes, within the pelvis on the outside of the uterus, or, rarely, in other parts of the body. An estimated 11 percent of American women aged 15 to 44 have endometriosis.
Endometriosis growths aren’t dangerous. But they're painful, and they can affect a woman’s ability to get pregnant.
Who’s at risk for endometriosis?
Endometriosis can affect any girl or woman of menstruating age, but it most often strikes women in their 30s and 40s. It also seems to be more common in white and Asian women compared to Black and Latinx women.
But age and race aren’t the only factors that could make endometriosis more likely. You might also be at higher risk if:
- You’ve never had children.
- Your periods last longer than seven days.
- Your menstrual cycle is shorter than 27 days.
- You have a health problem that blocks normal blood flow during your period.
- You have a family history of women with endometriosis.
Endometriosis symptoms
Symptoms endometriosis include the following:
- Super intense period cramps
- Chronic aching in your lower back or pelvis
- A deep-feeling pain during or after sex
- Intestinal discomfort
- Painful bowel movements
- Bleeding or spotting between periods as well as digestive problems (like diarrhea, constipation, bloating or nausea, especially during your period)
- Trouble getting pregnant and fertility problems
As for whether the condition can come on suddenly? There’s no clear answer, but experts do know that for many women, endometriosis doesn’t develop until their 30s or 40s. So if you start to notice uncomfortable symptoms that you didn’t have to deal with in your teens or 20s, it’s worth paying attention.
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What causes endometriosis?
The exact causes of endometriosis are still unknown. But many experts think that endometriosis is caused by:
- Problems related to period flow — like blood and tissue backing up to the fallopian tubes
- Genetic factors
- Immune system issues
- Hormones
What is known? When blood and tissue can’t exit your body, they can form painful growths and even scar tissue, while tissue that ends up in the ovaries can form endometriotic cysts. And all these growths can lead to discomfort, unpleasant periods and potential problems getting pregnant.
How does endometriosis affect fertility?
Experts are still trying to understand the relationship between endometriosis and fertility. But they suspect that implants of endometriosis tissue might affect the immune system, leading to inflammation and preventing sperm from getting into the egg or allowing an embroyo to develop.
The condition could make it harder for an embryo to implant on the wall of the uterus too. Endometriosis might also cause a woman’s immune system to attack an embryo instead of trying to protect it.
There’s no way to know for sure whether endometriosis will make it harder for you to get pregnant. But it does seem to be the case that the more endometrial growths a woman has, the more likely she is to experience fertility issues.
What are your chances of getting pregnant with endometriosis?
Women with endometriosis can still conceive, but it might take longer or be more difficult. Almost 40 percent of women who struggle with infertility have endometriosis, according to the American College of Obstetricians and Gynecologists (ACOG).
And when a woman with endometriosis does become pregnant, she may be nearly twice as likely to have a C-section, research shows.
Some women with endometriosis have no problem conceiving, while others need help. It’s hard to know which group you’ll fall into ahead of time, so you and your partner should start off trying to get pregnant naturally.
When should you talk to your doctor if you’re running into trouble? In general, couples where the woman is under 35 should seek help after trying to get pregnant for a year, while couples where the woman is over 35 should seek help after six months.
But some experts say women with endometriosis should seek help at the six-month mark, no matter how old they are. Talk with your partner and your doctor to decide what timeframe feels right for you.
If you’re having trouble conceiving, your doctor will perform a basic evaluation to assess your fertility. If your doctor suspects that you may have endometriosis, he or she may recommend a procedure to look into the abdomen and, if endometriosis is diagnosed, try to remove or damage the growths in an effort to improve fertility and decrease pain.
If surgery isn’t enough, the next steps are either in vitro fertilization or intrauterine insemination (IUI). In vitro fertilization is the more successful approach to acheive conception.
As for having a second child, your experience getting pregnant the first time won’t necessarily predict how things will go in the future. Pregnancy suppresses many of the inflammatory processes that are related to endometriosis, so it’s possible that getting pregnant a second time might even be easier.
Still, that’s not always the case. If you conceived after undergoing surgery to remove endometrial growths, it’s possible to develop new growths that cause problems the next time around.
What are the treatments for endometriosis?
If you think you might have endometriosis, start by talking with your doctor. Endometriosis can sometimes be mistaken for other conditions that cause pelvic pain, like pelvic inflammatory disease, ovarian cysts or even irritable bowel syndrome (IBS). But the right tests can confirm what you’re dealing with and help you get the appropriate treatment.
Your provider will conduct a preconception checkup or a pelvic exam to screen for the condition. If your practitioner suspects that endometriosis is a possibility, he or she will recommend a minimally invasive surgical procedure called a laparoscopy to get a better look inside the pelvic area and confirm the diagnosis. Ultrasounds and pap smears may also give your doctor a heads-up about abnormal growths.
There’s no cure for endometriosis. But addressing your symptoms can increase your odds of conceiving, not to mention reduce your pain and improve your quality of life. So it’s important to get treated.
Practitioners will use medications like gonadotropin-releasing hormone (GnRH agonists), oral contraceptives and synthetic forms of progesterone to treat symptomatic endometriosis. Stopping the patches from growing could make it easier to conceive after you stop taking the medication.
Your doctor might also recommend surgery to remove existing growths and improve youe odds of getting pregnant. If surgery isn’t effective in helping you and your partner conceive within six months, your doctor might recommend IVF or IUI.
IVF can help bypass the problems that make it harder to get pregnant with endometriosis — like the ability of the tubes to pick up the egg and the sperm reaching the egg. Using a GnRH agonist with IVF may improve outcomes. It temporarily stops your body from making hormones that trigger ovulation and spur the growth of endometriosis patches.
Some doctors recommend IUI with fertility drugs such as Clomid to maximize the benefit of the procedure.
What are the possible risks of endometriosis to the mother and baby?
Endometriosis can affect conception and up your chances of needing a C-section. It doesn’t necessarily mean you’ll have a high-risk pregnancy, but having the condition could increase the risk of certain problems, including:
Placenta previa
Research shows that women with endometriosis are anywhere from 1.6 to 15 times more likely to have placenta previa, where the placenta implants low in the uterus and covers all of part of the cervix. That could make you more likely to need a C-section.
Miscarriage
It’s upsetting to think about, but endometriosis can increase the chances of pregnancy loss compared to women who don’t have the condition. But remember that for many women with endometriosis, it is possible to have a healthy pregnancy and baby.
Preterm birth
Evidence also suggests that inflammation caused by endometriosis may be linked to a higher risk of giving birth prematurely. While there’s no way to prevent premature labor, your doctor can help you manage your risk factors and increase the chances of carrying your baby to term.
Preeclampsia
Recent evidence shows that endometriosis can make you somewhat more prone to developing preeclampsia. The good news is that regular prenatal care can often catch the condition in its early stages, when you may be able to control it with lifestyle changes.
Does endometriosis affect your ability to carry a baby to term?
Endometriosis can increase the risk for both miscarriage and preterm birth, as well as bleeding problems.
Those kinds of risks can be hard to deal with. It’s important to keep in mind that, overall, endometriosis-related complications are rare. Most experts agree that the condition doesn’t have a harmful effect on the majority of pregnancies, and there’s no known link between endometriosis and an increased risk of birth defects.
It can be nerve-wracking to wonder how endometriosis might affect your pregnancy. Having the condition might mean you need help conceiving, and you could be at higher risk for some complications during your pregnancy.
But remember: Many women with endometriosis are able to get pregnant — and have healthy, full-term babies. Just be sure to seek medical help early if you are concerned.
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