How Can Endometriosis Affect My Ability To Conceive
Endometriosis is a complex disease, the causes of which are still not well understood. What is clear, however, is that it causes a lot of suffering in the women who live with it, and that it can have a severe impact on their ability to get pregnant when they want to. The research says that between 30% to 50% of women diagnosed with endometriosis also struggle with infertility. The chance of a woman with untreated endometriosis conceiving each month is just 2-10%, compared to 15%-20% in the general population.
It is not always easy to discover how endometriosis is causing infertility for a specific patient, but there are several ways that it can complicate natural conception:
- Pain: Severe pelvic pain is one of the most significant symptoms of endometriosis, and unfortunately, most of the treatments that help are incompatible with pregnancy. Birth control pills, IUDs, and other hormonal treatments are often used to slow the growth of endometriotic deposits, which can reduce pain and relieve the heavy periods caused by endometriosis. If you want to get pregnant, youll have to stop these treatments, which could lead to your severe symptoms returning. Pain during intercourse is also a common symptom and it can get worse in the time period that the endometriosis is untreated, which can make it more difficult to conceive naturally.
How Endometriosis Is Diagnosed
As the symptoms of endometriosis are similar to a range of other conditions, it can be hard to get a diagnosis but if you have one or more symptoms from the first list above, your doctor should suspect endometriosis and offer you an abdominal and pelvic exam.
Chances Of A Natural Pregnancy
If you have been diagnosed with endometriosis before you even thought about getting pregnant, you may wonder if it’s worth trying to get pregnant on your own before seeking fertility treatment. The answer is simple: yes, absolutely.
Of course, you should always talk to your healthcare provider about your specific situation. But endometriosis doesnt automatically mean you will experience infertility.
If you have endometriosis, you will usually be advised to try conceiving naturally for six months . If you don’t conceive within this time frame, you should speak with a fertility specialist.
Some women with endometriosis may decide to go straight to a fertility specialist. This is also a reasonable option.
If youre 35 years or older, you may not want to take the time to try to conceive on your own. Your natural fertility declines with age at a faster rate after age 35, and those extra six monthsespecially because you already know you have endometriosismay not be wise. Our Doctor Discussion Guide below can help you start that conversation with your healthcare provider to clarify any questions you might have.
Endometriosis Doctor Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
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Underlying Causes Of Infertility
We dont fully understand how endometriosis impacts fertility. When endometriosis causes ovarian cysts , or endometrial scar tissue blocks the fallopian tubes, the reason for infertility is clearer. However, women with endometriosis who dont have endometrial ovarian cysts or blocked fallopian tubes may still experience reduced fertility.
There are several possible theories on why endometriosis makes it harder to get pregnant.
Endometriosis Stages And Infertility
Your healthcare provider may have referred to your endometriosis in terms of stages. During surgery, doctors take into account the location, amount, and depth of endometrial deposits. Based on this, they score the level of endometriosis.
There is stage 1, stage 2, stage 3, and stage 4. These stages are used to help describe and evaluate the severity of endometriosis, with stage 1 being mild endometriosis and stage 4 being severe. But do these stages mean anything with regards to your odds of conception? Yes and no.
As a general rule, women with stage 1 or 2 endometriosis are less likely to experience infertility than women with stage 3 or 4 endometriosis.
The stage of endometriosis can also help your healthcare provider come up with a treatment plan. For example, a woman with stage 2 endometriosis may want to try to conceive on her own for a while. A woman with stage 3 endometriosis may proceed directly to IVF treatment.
However, the stage of your endometriosis cannot predict whether fertility treatments will be more or less successful. It is possible to have stage 2 endometriosis and go through numerous failed IVF treatments. And its possible to have stage 4 endometriosis and conceive on your first cycle.
Bottom line: Dont put too much weight on the stage of your endometriosis.
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Surgery To Improve Fertility With Endometriosis
For those with minimal or mild endometriosis surgery can improve fertility and should be discussed with you if you are finding that you are not able to get pregnant and the condition has been found to be a possible cause of your infertility.
- The most common type of surgery is laparoscopy, also known as keyhole surgery. This involves a thin tube with a camera at the end being inserted into your abdomen through a small cut made in your skin, usually your belly button. Through this camera and possibly additional small cuts around your bikini line either laser or heat or scissors can be passed to remove or destroy the tissue. For this procedure, you will be put to sleep under general anaesthetic so you will not feel any pain. This is an effective treatment but there is a risk of some tissue being left behind or re-growing, so the endometriosis can recur.
- The other type of surgery that can be performed is a laparotomy. This surgery should only be done in very few exceptions as is more invasive with a wider cut along the bikini and removal of the tissue attached to the affected area. Centres of expertise in the UK, organised by the British Society of Gynaecological Endoscopy, are usually able to perform most surgeries using the keyhole method.
How long should someone wait until after a laparoscopy to try to conceive?
Are there any reliable statistics on chances of conceiving after successful surgery?
Can Endometriosis Cause Ectopic Pregnancy
More research is needed, but research suggests a link between endo and ectopic pregnancy.
4. Fact: Women with endometriosis could have an increased risk of ectopic pregnancy.
A meta-analysis of 15 studies in the February 2020 issue of the Journal of Minimally Invasive Gynecology concluded that women with endometriosis have a 2.66 higher risk of having an ectopic pregnancy a pregnancy that occurs outside the uterus, usually in the fallopian tube compared with women who dont have the disease. The previously mentioned study in the September 2019 issue of Obstetrics and Gynecology found that endometriosis was associated with a 46 percent increased risk of ectopic pregnancy.
This elevated risk may be because endometriosis can affect the fallopian tubes. We know that fallopian tube damage definitely increases the risk of ectopic pregnancy, so its biologically reasonable to assume that if endometriosis is present involving the tube, ectopic pregnancy may be a higher risk, Dr. Woodall says.
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Lifestyle Choices Reduce Inflammation And Enhance Fertility Chances
Your diet, exercise and lifestyle choices can have a big impact on fertility and endometriosis, in particular.
A number of studies demonstrate a correlation between women with more severe symptoms and higher-intakes of red meat, trans-fats, caffeine/alcohol, with lower-intake of vegetables.
Focusing on diets that optimize intake of fresh veggies, fruits, whole grains and lean meat, and that limit intake of processed foods and simple carbohydrates, is a smart move for any woman planning to get pregnant.
What Treatments Can Help Me Get Pregnant With Endometriosis
If youre planning to get pregnant or if youve been trying for some time without success, dont wait before seeking help. For most patients with endometriosis, time is an important factor. The condition is progressive, and the sooner you can get pregnant, the better.
Any trip to the doctor to talk about your fertility should begin with a full fertility workup. There are a wide range of diagnostic fertility tests available which can shed light on what may be happening inside your body thats preventing you from getting pregnant. Armed with this information, your fertility expert can work with you to draw up a treatment plan that makes sense for your unique case.
The good news is that there is help out there for women who want to get pregnant in spite of endometriosis. Medication, surgery, and assisted reproductive therapies have made a difference for thousands of patients dealing with this debilitating disease and allowed them to achieve their dream of a healthy pregnancy and birth.
- Intrauterine insemination with controlled ovarian stimulation : IUI combined with hormonal fertility medication can help in some cases of mild/moderate endometriosis, when the patient does not have any blockages and is able to ovulate. Research has shown that the cumulative live birth rate was five times higher after IUI-COH, though still lower than for patients without endometriosis by about 21%.
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Fertility Coach Program Cures Endometriosis
We customize our fertility coach program depending upon the stage of endometrial cyst. In endometrial stage 1 & 2 then we dont let the cyst grow further and in most of the cases we have successfully helped women to conceive naturally while still having mild to moderate cyst.
If the endometriosis cyst is of stage 3 or 4, then we recommend to get it surgical treated and after that we help women in her conception.
Our fertility coach program has successfully cured 80% of the endometriosis cases and helped women to conceive.
Struggling With Infertiltycould The Cause Be Pcos Or Endometriosis
Endometriosis is a condition in which the tissue that lines the inside of your uterus grows outside the uterus but continues to act as it normally would: thickening, breaking down, and inducing bleeding as part of the monthly menstrual cycle.2
Three telltale symptoms of endometriosis are:
- Painful periods
- Pain with intercourse
- Difficulty conceiving
If you experience at least two of these symptoms, you might consider discussing the need to be tested for endometriosis, says Dr. Richard-Davis. With regard to miscarriages, both doctors emphasized that endometriosis is an unlikely cause of miscarriages on its own but when occurring with at least one other sign, it may suggest the need to discuss your concerns with your healthcare provider. In addition, other signs such as heavy bleeding or bleeding between periods and pain during urination or bowel movements can also point to endometriosis.
Polycystic ovary syndrome, more commonly known as PCOS, is a multifactorial disorder that impacts hormonal, metabolic, and reproductive functions. PCOS is characterized by what Dr. Richard-Davis calls a very specific constellation of symptoms related to irregular menstrual cycles and excess circulating androgens. Androgens are the sex hormones that are usually higher in men and are responsible for excessive hair growth as well as adult acne in women.
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Endometriosis Pain Mistaken As Period Pain
Many girls & women complain of excessive pain during periods but by default have learned to accept and normalize this pain, because we grew up hearing things like
Periods mai pain toh hota hi hain, konsi baadi baat hain?
Shaadi ke baad periods mai changes aate hi hain, sehan karlo
Hey you are PMSing, Be strong!
But if you are having these symptoms than dont get mistaken as period pain.
1. Painful menstrual cramps
2. Pain during or after sex
3. Painful bowel movements
4. Painful urination during menstrual periods
5. Pain in the intestine or lower abdomen
6. Excessive bleeding during periods
7. Infertility
8. Other symptoms may be fatigue, constipation, bloating or nausea.
Understanding The Relationship Between Endometriosis And Fertility
The first thing you should know is that theres not a definite link between endometriosis and infertility. Some women who have endometriosis have no problem getting pregnant, while others do. Nationally, 30%-50% of women with endometriosis will face some infertility issues, but that means 50%-70% will have no problem at all. So be encouraged.
To understand why endometriosis might interfere with your pregnancy plans, you need to understand whats going on in your uterus. Immediately following conception, a fertilized egg implants itself in the lining of your uterus. But if you have endometriosis, the tissue that lines your uterus has grown outside of its assigned organ and can cause some problems.
That roaming endometrial tissue still acts like it did when confined to your uterus gradually getting thicker and trying to slough off like it does during your menstrual cycle but it has nowhere to go. This can eventually result in a buildup of scar tissue and may cause complications with reproduction if not treated.
An important takeaway here is that if you dont want to get pregnant, do not assume your endometriosis has made you infertile. Plenty of women with this condition have no problems getting pregnant. So practice safe birth control to avoid an unwanted pregnancy.
If you do want to become pregnant, here are the some of most common endometrial complications that could interfere with your efforts, and how our doctors at Womens Specialists of Fayette can help.
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How Is Endometriosis Treated
Endometriosis needs the female hormone estrogen to develop and grow. Birth control pills and other drugs that lower or block estrogen can be effective in improving pain symptoms. For patients who wish to become pregnant, medical therapy may be considered prior to attempts at conception, but this treatment usually does not improve pregnancy rates.
If endometriosis is seen at the time of surgery, your doctor will surgically destroy or remove the endometriosis and remove the scar tissue. This treatment will restore your normal anatomy and will allow your reproductive organs to function more normally. Your chances of becoming pregnant are improved after surgical treatment, especially if your endometriosis is in the moderate or severe range. The combination of surgical and medical therapy may be beneficial in patients attempting to conceive through in vitro fertilization . Overall, treatment is highly individualized for each patient.
Revised 2016
A Sharp Rise In Endometriosis
Many women are suffering in silence due to lack of awareness. About 25% of women having endometriosis suffer from fertility issues and more than 90% suffer from pain in different reproductive organs. Many doctors claim that there is a sharp rise of endometriosis cases in recent years, so much that it is now considered as a normal curable infertility condition. But the bitter truth is
Endometriosis is still an alien infertility condition for majority of the population.
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Autoimmune Diseases May Confound The Prospect Of Pregnancy
Women with diabetes or other metabolic disorders are at increased risk of having other conditions that will likely add another layer of complexity to pregnancy, endometriosis, and PCOS. As if having PCOS or endometriosis isnt enough of a challenge, women who have thyroid disorders may face an even more complicated path to pregnancy. Women who have hypothyroidism may find the effort to lose excess weight more difficult, and even subclinical hypothyroidism can interfere with ovulation.9
In exploring the reasons behind your infertility, the experts recommend that you have your thyroid hormone levels checked if you havent already had your blood work done. Its important to work with your doctor to achieve a healthy thyroid function before attempting pregnancy.
Autoimmune disorders like systemic lupus can cause complications for women with endometriosis. Women who are under treatment for lupus usually receive steroids and immunosuppressant agents, which can worsen endometriosis symptoms by reducing the bodys ability to fight the growth of excess endometrial tissue. If you have these or other confounding conditions, youll be in good hand if you work with a team of specialists who can guide you to make decisions that are safest and most sensible for your health and pregnancy goals.
What Do Endometriosis Types And Stages Mean For Fertility
There are several different classification systems for endometriosis. The one from the American Society for Reproductive Medicine is widely used: It includes four stages of endometriosis, based on the location, extent, and depth of the endometriosis implants, the presence and severity of adhesions , and the presence and severity of endometriomas . While stage 1 involves few superficial implants and mild adhesions, stage 4 is characterized by deep endometriosis implants, large endometriomas, and many dense adhesions.
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Underlying Causes Of Infertility In Endometriosis
The underlying causes of infertility in endometriosis vary from person to person. Some women simply experience difficulty conceiving due to hormonal imbalances caused by endometriosis. Others suffer from tubal blockage, which prevents sperm from reaching the egg. Still others have problems with implantation.
