How endometriosis affects fertility
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Endometriosis is a chronic condition in which tissues similar to the lining of your uterus grow outside of the uterus. This can include your fallopian tubes, ovaries, bladder and bowels.
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Some women with endometriosis have severe pelvic pain, heavy menstrual periods, fatigue, nausea and diarrhea during their period. Endometriosis also is a leading cause of infertility.
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Treatment for endometriosis and infertility includes medicine, surgery and assisted reproductive techniques like intrauterine insemination and in vitro fertilization. Many women who have treatment get pregnant.
How endometriosis affects fertility
Endometriosis is a chronic condition that affects about 11% of women in the United States. It can cause pelvic pain, heavy menstrual periods and infertility. But there is hope for women with endometriosis who want to get pregnant. In recognition of Endometriosis Awareness Month, here we examine the relationship between endometriosis and fertility.
What is endometriosis?
The endometrium is the lining inside your uterus. Endometriosis is when tissues similar to the endometrium grow outside your uterus. They can grow on your ovaries, fallopian tubes, bladder or intestines.
These tissues act like the endometrium. They thicken, break down and bleed during menstruation. The growths also can cause inflammation, cysts, adhesions and scarring.
It’s not clear what causes endometriosis. Doctors think it may be due to a few conditions. These include:
- Cell changes: Hormones or immune factors may change cells into endometrial cells.
- Endometrial cell travel: Endometrial cells may move through your blood or lymph system to other parts of your body.
- Genetics: Women with a family history of endometriosis are more likely to have it.
- Retrograde menstruation: In this condition, menstrual blood and tissues flow backward. They go through the fallopian tubes into the pelvic cavity.
- Surgical scars: Endometrial cells can attach to scar tissue from a surgery in the stomach region, like a C-section.
Symptoms of endometriosis
The most common sign of endometriosis is very painful menstrual periods. This is beyond minor discomfort. Other symptoms include:
- Discomfort during sexual intercourse
- Extremely painful menstrual cramps
- Fatigue, nausea or diarrhea during your period
- Heavy periods or bleeding between periods
- Infertility
- Severe pain with urination or bowel movements
“Endometriosis is a chronic disease that can affect nearly every aspect of a woman’s life,” says Theresa Franks, M.D., a gynecologist at St. Jude Heritage Fullerton – Laguna Uro/Gyn. “It can even lead to depression and anxiety.”
There are three primary types of endometriosis. You can have one or more. The types include:
- Superficial peritoneal: Growths or cysts in the lining of the abdomen
- Endometriomas: Dark, fluid-filled cysts that grow on the surface of or inside the ovaries
- Deeply infiltrating: Growths on organs near the uterus, such as the vagina, bladder and bowel
Superficial peritoneal endometriosis is the mildest form, and deeply infiltrating endometriosis is the most severe.
The connection between endometriosis and infertility
Some women question whether having endometriosis makes it harder to get pregnant.
Endometriosis can cause infertility in some women. According to Dr. Franks, between 30% and 50% of women with endometriosis are infertile. “Women with endometriosis have a lower chance of conceiving than women without this condition,” she says.
Typically, women without endometriosis have a 10%-20% chance of getting pregnant each month. For women with endometriosis, the pregnancy rate is 1-10%.
As tissue grows, cysts can develop. This can block or damage your ovaries or fallopian tubes with scar tissue. That may prohibit an egg from being fertilized.
Endometriosis also can negatively affect fertility by:
- Causing chronic inflammation in the pelvis
- Changing the immune system
- Creating a hormone imbalance
- Decreasing egg quality
- Impairing egg implantation in the uterus
- Preventing an embryo from implanting
Doctors use the endometriosis fertility index (EFI) to estimate the likelihood of getting pregnant naturally. The EFI is based on your:
- Age
- Function of your ovaries and fallopian tubes
- Length of infertility
- Medical history
- Prior pregnancies
“The severity of your endometriosis matters,” Dr. Franks points out. “Women with mild endometriosis have a higher chance of conceiving naturally compared to those with severe endometriosis.”
Diagnosing and treating endometriosis
See your doctor or gynecologist if you think you may have endometriosis. They will discuss your health history and symptoms and do a physical exam. You may also have other tests. These include:
- Blood test: To measure your hormone levels
- Laparoscopy: To look inside your abdomen for endometrial tissue
- MRI: To see endometrial tissue growth
- Ultrasound: To check for cysts on your ovaries
There’s no cure for endometriosis, but treatment can help control symptoms. Options include:
- Hormone suppression: This involves stopping your period with birth control pills (oral contraceptives), gonadotropic-releasing hormones (GnRH) or an intrauterine device (IUD).
- Pain relievers: Medicines like acetaminophen or non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen can reduce pain.
- Surgery: Laparoscopic surgery removes the endometriosis tissue. In severe cases, a surgeon may recommend removing your ovaries or uterus (hysterectomy).
“Many women experience pain relief after surgery,” Dr. Franks says. “We often suggest combining surgery with medications to improve the outcome.”
However, the risk of endometriosis returning after surgery is high, she adds. You can help prevent this by taking birth control pills or getting pregnant after surgery.
Treatments to improve fertility with endometriosis
Women with endometriosis who want to conceive should see their doctor before they want to get pregnant to discuss their options, Dr. Franks recommends.
“Roughly 50-70% of women treated for endometriosis can successfully conceive,” she says. “But this can vary depending on the severity of the endometriosis and individual circumstances.
Lifestyle changes may improve your chances of conceiving. Endometriosis tissue grows due to estrogen. You can decrease your estrogen levels by avoiding alcohol, limiting caffeine and exercising regularly.
If you’re having trouble getting pregnant, a fertility specialist or reproductive endocrinologist can help. Treatment options include:
- Intrauterine insemination (IUI): A doctor injects semen directly into your uterus to make it easier to fertilize an egg.
- In vitro fertilization (IVF): Doctors remove an egg from your body and fertilize it in a lab. Then they implant it in your uterus.
- Medicine: Medication stimulates your ovaries to release more than one egg per menstrual cycle.
Depending on your condition, your doctor may start with medicine. They may proceed to IUI or IVF if necessary. Many women with endometriosis who undergo fertility treatments are able to become pregnant.
Support for women with endometriosis
Endometriosis affects your life and may impact your fertility. But you aren’t alone. Several organizations offer resources and support groups. These include:
Endometriosis Association (EA)
Endometriosis Foundation of America
Our experienced teams at Providence also can answer your questions and provide comprehensive, compassionate treatment for endometriosis and infertility.
Contributing caregiver
Theresa Franks, M.D., is a gynecologist at St. Jude Heritage Fullerton – Laguna Uro/Gyn in Fullerton, California.
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Related resources
Endometriosis: When pain is more than just a ‘bad period’
Endometriosis: Separating truths from misconceptions
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
