Endometriosis doesn’t directly cause infertility, but there’s a link between the condition and difficulty getting pregnant. Depending on the severity of your condition, endometrial tissue growth can affect your ability to conceive naturally.

Medically reviewed by Dr Rebecca Kingston MBChB, Medicine

What is endometriosis?

Endometriosis is a long-term condition where tissue like the lining of your womb grows in other areas of your body — like your ovaries and bowel. This tissue can become inflamed, and form growths called implants or lesions. 

The exact cause of endometriosis isn’t known. But some factors like genetics, retrograde menstruation (where menstrual blood flows backwards instead of through the vagina), or issues with your immune system, might play a role. 

Symptoms of endometriosis 

The severity of endometriosis varies from one person to the next, but symptoms can include: 

  • severe pain in your lower tummy or back — this increases during your period and can interfere with daily activities 
  • heavy bleeding during your period 
  • nausea, constipation, or diarrhoea during your period 
  • painful bowel movements during your period 
  • difficulty getting pregnant
  • pain during and after sex

How severe your endometriosis is, is based on a 4-stage scale: 

  • Stage I: minimal endometriosis — small implants(the growths forming from inflamed tissue) are present in the lining of your pelvis or abdomen. 
  • Stage II: mild endometriosis — implants are slightly larger and deeper and can form scar tissue.
  • Stage III: moderate endometriosis —there are many deep implants and you might have a thick band of scar tissue, also known as an adhesion. You might also have small cysts on your ovaries. 
  • Stage IV: severe endometriosis  — you have several deep implants and adhesions, as well as larger cysts on your ovaries. 

The severity of pain and the amount of period blood isn’t linked to the amount of tissue and implants in your body. You might experience severe pain with minimal endometriosis. 

How does endometriosis affect your ability to get pregnant? 

Difficulty getting pregnant or not being able to get pregnant at all (infertility) is one of the main complications of endometriosis. 

Endometriosis doesn’t directly cause infertility. But researchers have some theories about how endometriosis might affect your ability to get pregnant naturally, including:

  • scarring or tissue from endometriosis can make it difficult for the egg to travel from the fallopian tubes to the uterus
  • inflammation produces chemicals called cytokines — which can make it difficult for sperm to fertilise your egg cells
  • tissue on your ovaries can make it difficult for eggs to be released.

Are there treatments for endometriosis-related fertility?

While endometriosis can make it more difficult to conceive, it’s still possible to get pregnant. There are treatments to help increase your chances of conceiving with endometriosis. 

Treatment usually depends on several factors — including the severity of your endometriosis and your age. Three types of treatments are usually considered for infertility:

  • medication or injections like clomifene or gonadotrophins — these help to stimulate ovulation
  • surgery to remove implants and scar tissue 
  • assisted reproduction like intrauterine insemination (IUI) or in vitro fertilisation (IVF)

Evidence has shown that oral medication or injections alone aren’t usually enough to treat infertility linked to endometriosis. So depending on the severity and location of the implants, further treatment might be recommended.

Surgery 

Surgery to remove visible tissue around the ovaries and fallopian tubes (where it’s possible to do so without major risk) might increase your chances of pregnancy. 

There are two types of surgery for endometriosis:

  • a laparoscopy (keyhole surgery) — implants are removed with the heat of a laser through a small incision in your stomach
  • a more invasive procedure called a laparotomy — it’s only for a few exceptions, but a larger incision is made in the lower stomach to remove implants with surgical equipment. 

Assisted reproductive techniques 

Assisted reproductive techniques like intrauterine insemination (IUI) or in vitro fertilisation (IVF) are established fertility treatments for endometriosis. 

These treatments are usually recommended if you haven’t been able to get pregnant for a considerable time after surgery or if you’ve been trying for two years. 

How will endometriosis affect your pregnancy?

If you conceive, your pregnancy should be normal. In fact, pregnancy and the absence of your periods might temporarily relieve endometriosis pain. 

Increased progesterone levels during pregnancy might even cause temporary pain relief and cause implants to shrink. But, symptoms might return when your period is back to normal after birth. 

Pregnancy will differ from person to person — depending on your body’s hormone production and response to pregnancy.

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References

Fadhlaoui, A., Bouquet de la Jolinière, J., & Feki, A. (2014). Endometriosis and infertility: how and when to treat?. Frontiers in surgery, 1, 24

Marcoux S., Maheux R., Berube S (1987). Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. New England Journal of Medicine; 337: 217-22. 

National Health Services (2019). Endometriosis. Retrieved 22 March 2021 from https://www.nhs.uk/conditions/endometriosis/ 

National Health Services (2020). Infertility: treatment. Retrieved 23 March 2021 from https://www.nhs.uk/conditions/infertility/treatment/  

Senapati, S., & Barnhart, K. (2011). Managing endometriosis associated infertility. Clinical obstetrics and gynecology, 54(4), 720. 

Tanbo, T., & Fedorcsak, P. (2017). Endometriosis‐associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta obstetricia et gynecologica Scandinavica, 96(6), 659-667..

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