Endometriosis and infertility: Statistics, treatment, and getting pregnant

Research has found that infertility affects around 30–50 percent of people with endometriosis.

Endometriosis lesions can cause inflammation in the area and may form scar tissue, as well as stick different organs together. They also bleed, similarly to the regular uterine lining, in response to hormones. All of these things can cause pain.

Endometriosis can start as early as a person’s first period, and it can last beyond menopause, particularly in severe cases with a lot of scar tissue.

In addition to infertility, other symptoms of endometriosis include:

• pain during sex
• pain with ovulation
• fatigue
• painful cramps
• frequent urination
• low back pain
• painful bowel movements
• constipation or diarrhea

Symptoms tend to get worse around the time of a person’s menstrual period.

Endometriosis and infertility

Infertility is a common symptom of endometriosis. Some people only find out that they have the condition when they experience difficulty getting pregnant.

Up to half of people with endometriosis are infertile, but researchers do not know exactly why this is.

They do have a few theories, including:

• Inflammation causes the production of chemicals known as cytokines. These cytokines can inhibit the sperm and egg cells, making fertilization more difficult.
• Scarring and adhesions that occur with endometriosis can block the fallopian tubes or uterus, making it difficult for the sperm to meet the egg.
• Endometrial tissue on the ovaries can inhibit ovulation, preventing the release of an egg.

Some research has found that women who are infertile are six to eight times more likely to have endometriosis.

Treatment

There are many different treatment options to help manage endometriosis. These treatments may change if a person is pregnant or trying to get pregnant:

• Pain medication: Prescription or over-the-counter pain-relievers can help reduce endometriosis pain. However, if a person gets pregnant, a doctor may advise them to stop using some types of pain-relievers, as they can affect the developing fetus.
• Hormonal medications: Pills and other devices containing synthetic estrogen, progestin, or both are a common way to manage endometriosis symptoms. However, they are not suitable for women trying to get pregnant or who are already pregnant.
• Surgery: During laparoscopy, a specialist will insert a fiber optic instrument through small incisions in the abdomen to view the organs inside. Laparotomy is major open-abdominal surgery. Both of these procedures aim to remove the endometrial lesions while leaving the surrounding healthy tissue intact. Surgery to remove lesions may improve a person’s chance of getting pregnant.
• Infertility treatment: A woman with endometriosis may require infertility treatment in order to conceive. In vitro fertilization may be the best option for many women with endometriosis, especially those who did not conceive after laparoscopy.
• Hysterectomy: Some doctors recommend a hysterectomy, or the removal of the uterus, especially for women who do not wish to become pregnant. However, a hysterectomy is not a complete cure for endometriosis, as there is a small chance that symptoms may return after surgery.

When speaking to a doctor about endometriosis treatment, it is vital to be clear about the goals of the treatment, such as wanting to improve fertility and get pregnant.

Some treatments for endometriosis are not suitable for a person who is trying to conceive.

Someone who is already taking hormonal medications to manage their symptoms, for example, will need to stop taking them if they are actively trying to get pregnant.

Outlook

Endometriosis is a common disorder with a variety of symptoms. While some people with endometriosis have fertility issues because of the condition, many get pregnant and deliver healthy babies.

Some women may need fertility treatments to become pregnant. Treatment for endometriosis, such as laparoscopic excision and unblocking fallopian tubes, may also help.

A woman who suspects that endometriosis is affecting her fertility should speak with a doctor about all of the options.

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