What is endometriosis?

Endometriosis occurs when tissue that is similar to endometrial tissue, or the tissue lining the uterus, grows outside of the uterus. It commonly occurs in women aged 30s to 40s. Endometriosis is one of the most common causes of pelvic pain in women. It also typically manifests as dysmenorrhea and abnormal uterine bleeding. But how does endometriosis affect a woman’s reproductive abilities? Can you get pregnant with endometriosis? Read on to learn more.

While the exact cause of endometriosis is still unclear, studies have found that having a family history of endometriosis and beginning menstruation at an earlier age may increase the risk for developing the condition. Endometriosis can be diagnosed using a procedure called a hysteroscopy, wherein the uterus is directly visualized using a scope.

Endometriosis requires life-long treatment with the goal of reducing the need for surgical procedures. The choice of treatment is chosen by each individual woman depending on their age, severity of symptoms, and desire for fertility.

Can you get pregnant with endometriosis?

Endometriosis has been found to negatively impact fertility. Couples wherein the woman has endometriosis have a lower fecundity rate, or a lower potential to have children. In addition, studies have shown that infertile women are up to 8 times more likely to have endometriosis than fertile women. There are several theories suggesting why endometriosis affects fertility. Some suggest that fertility is affected due to distorted pelvic anatomy, ovulatory abnormalities, and altered hormonal function. However, no consensus has been reached.

What are the effects of endometriosis on pregnancy?

During pregnancy, endometriosis and its associated symptoms appear to improve. This is in part due to the altered hormonal environment. However, this does not mean that the condition is getting better. In fact, many case reports have described the complications that may arise during pregnancy among women with endometriosis. These include:

• Intestinal perforation
• Acute appendicitis
• Hemoperitoneum or pooling of blood in the abdominal cavity

Endometriosis has also been shown to have negative effects on pregnancy outcomes. Pregnant women with endometriosis are at an increased risk of:

• Preterm birth
• Preeclampsia
• Cesarean delivery
• Miscarriage
• Ectopic pregnancy
• Placenta previa
• Antepartum and postpartum hemorrhage

How can you increase fertility if you have endometriosis?

In most cases, a combination of both medical and surgical procedures is required to improve symptoms and increase fertility.

Women with a Stage I or II endometriosis have an option to proceed with natural conception, but they can also benefit from ovulation induction, intrauterine insemination (IUI), and Assisted Reproductive Technology (ART).

While ART has been found to be more effective compared to other methods, it is costly and might not always be accessible to the patient. Ovulation induction and IUI, on the other hand, are less expensive, but can result in the delay of conception if ineffective.

The choice of treatment for infertility among women with endometriosis is based on clinical indications, the patient’s age and preference, and procedure risk.

The following are the current recommendations for women with endometriosis who want to get pregnant:

• For females younger than 35 years who want to try natural conception, six months of timed intercourse is advised. If unsuccessful after six months, ovulation induction with clomiphene citrate (CC) and IUI is recommended.
• Females younger than 35 years who prefer infertility treatment (rather than natural conception), or who do not conceive naturally may proceed with ovulation induction with CC or letrozole plus IUI.
• For women older than 35, the general recommendation is to proceed with ART. However, clomiphene may also be given if ART is not possible for any reason. ART has been shown to reduce the time to conception. Moreover, ART offers the option to freeze excess embryos for possible future use.

Key takeaway

Endometriosis is a benign gynecologic condition that presents as pelvic pain, abnormal uterine bleeding, and dysmenorrhea. Women suffering from endometriosis may find it harder to conceive compared to those who are not. Fortunately, there are several medical and surgical procedures that can increase fertility despite having this condition.

Learn about other Women’s Health Issues here.