How does endometriosis affect fertility?

Although endometriosis isn’t visible to the naked eye, many women who suffer from it certainly feel its effects, including:

• Painful periods
• Heavy bleeding during periods
• Discomfort during sex
• Difficulty becoming pregnant

In fact, 30 to 50% of women with endometriosis have difficulty becoming pregnant. Endometriosis occurs when your endometrium, or uterine lining, grows on the outside of your uterus onto your fallopian tubes and ovaries. From there, it sets up shop on the inside or outside of your reproductive organs.

While doctors aren’t sure why this happens, they believe it’s due to retrograde menstruation, which is when some of your endometrial tissue flows backward through your fallopian tubes and into your ovaries and abdominal area.

During your period, this misplaced tissue mimics the same actions as your endometrium during Aunt Flo’s monthly visit, meaning it bleeds like your uterine lining during your period. However, unlike your uterine lining—which flows from the uterus, through the cervix, and out through the vagina—the tissue on your ovaries or fallopian tubes has no exit strategy.

This causes the endometrial tissue to become trapped, which can initiate several other problems—some of which affect your fertility:

• Ovarian cysts – During your period, your uterus sheds its old uterine lining. At the same time, the rogue tissue in your ovaries also bleeds but has nowhere to go. Over time, accumulated blood and tissue can form an ovarian endometrioma—a cyst filled with menstrual blood. Endometriomas sometimes block the release of an egg during ovulation, obstructing its passage into the fallopian tube.
• Adhesions – If too much uterine lining grows in unwelcome places, it can cause scars known as adhesions to form on your reproductive organs. This scar tissue can cause other tissues to stick together, distorting your organs and making it more challenging for the egg to travel from the fallopian tube to the uterus. Likewise, adhesions also make it difficult for sperm to reach a mature egg.
• Chronic inflammation – Endometriosis causes substantial localized inflammation, which can impair fertility on several fronts. Chronic inflammation may lead to hormonal disruptions (which can throw your reproductive cycle out of whack) and structural disruptions, which can inhibit implantation and increase risk of pregnancy loss.

Getting Pregnant with Endometriosis

If you have endometriosis, it may take several attempts to emerge with a pregnancy test that reads YES. Around 30% to 50% of women with the condition struggle to get pregnant initially, but many are eventually able to conceive and carry a healthy baby to term.

If you want to try for a baby naturally, be sure to keep the following in mind:

• Talk it through with your doctor – Depending on how severe your endometriosis is, it may be best to seek out alternative ways of expanding your family. While some people with endometriosis can successfully conceive, high-risk cases may see pregnancy complications down the line. Get insight from your doctor on your condition’s severity, and whether it has potential to put you or your baby at risk.
• Take time to unwind – By now, you may be sick of being told to “just relax” if you’re trying for a little one. But if you have endometriosis, this rings especially true. Not only can reducing stress help regulate your ovulation schedule, but it can also assist with managing the pain that comes with endometriosis. At least for now, try scaling back on exercise, getting plenty of sleep, or trying meditation techniques to keep a calm mind.

What to Do If You’re Having Difficulty Getting Pregnant

If you’ve been trying for more than six months and have yet to see those two pink lines on a pregnancy test, it’s time to schedule an appointment with your OBGYN. During your visit, they may perform a pelvic exam to check for abnormalities or cysts around your reproductive organs.

They may also conduct other tests to confirm your endometriosis diagnosis, including:

• Transvaginal ultrasound
• MRI
• Laparoscopy
• Hormone and blood tests

After completing these examinations, your OBGYN can refer you to a specialist who will discuss the various treatments available to improve your chances of conceiving.

Fertility Treatment Options for Endometriosis

There are several factors fertility specialists will evaluate before recommending a fertility protocol for women with endometriosis:

• Your age – Doctors often recommend that women under the age of 35 first undergo a laparoscopy to remove cysts and excess tissue caused by endometriosis. Afterward, patients will try to naturally conceive for a while before considering other treatments.Because the quality of eggs deteriorates at age 32, and then again more rapidly after age 37, doctors may suggest that women over 35 pursue ART-based fertility treatments (like IVF).
• Stage of disease – Another factor doctors consider is your current stage of endometriosis (there are four stages). Stages one and two are milder, with small traces of endometrium tissue in the body and minimal scar tissue. Stages three and four are more serious and may include endometriomas and extensive adhesions on the reproductive organs, making it more challenging to conceive.
• Treatment costs – Fertility treatments for people with endometriosis aren’t always covered by insurance, especially elective procedures like IVF. It’s important to talk to your doctor about the costs associated with each treatment option so you can find one that works best for your budget.

After evaluating these factors, there are typically four fertility treatment options your healthcare provider may recommend.

#1 Laparoscopic surgery

Laparoscopies are used to remove cysts and scar tissue from the reproductive organs, lessening the distortions caused to your fallopian tubes or ovaries. This can facilitate eggs’ movement down the fallopian tube, where they’ll be more likely to meet their prince charming (i.e., the lucky sperm!).

#2 Fertility medication

Clomiphene (a.k.a. Clomid) is a fertility medication many doctors prescribe to help your body produce two or three mature eggs during ovulation. It works by tricking your body into thinking you have low estrogen levels, which can increase the production of two important hormones:

• Follicle-stimulating hormone (FSH) – FSH helps your ovary create one or more egg follicles.
• Luteinizing hormone (LH) – LH stimulates ovulation, often more quickly than normal.

Clomid is typically taken on day two of your menstrual cycle and for the next five days. This helps trigger early ovulation, which tends to occur 5 to 12 days after completing a full pill cycle.

#3 Intrauterine Insemination (IUI)

Doctors may recommend Intrauterine Insemination alongside the use of fertility medications like Clomid. When used together, studies indicate that women are three times more likely to become pregnant than when trying to conceive naturally.

If your doctor thinks you’re the ideal candidate, your IUI treatment should move through the following stages:

1. You’ll take 1 cycle of Clomid to trigger ovulation. Since insemination isn’t a one-size-fits-all scenario, you’ll also be monitored closely to determine the proper time for insemination.
2. Your partner or sperm donor will provide a semen sample. Once in hand, the little guys will undergo a sperm wash to make sure the doctors have the highest-quality swimmers for the insemination.
3. During ovulation, you’ll go to your doctor’s office, where they’ll insert a speculum into your vagina to view your cervix. From there, they’ll place a small tube filled with the champion sperm into your uterus, where one of them will hopefully fertilize the egg.
4. In two weeks, you’ll take a pregnancy test to see if the procedure was successful (and that you’re expecting!).

#4 In Vitro Fertilization (IVF)

IVF involves fertilizing a mature egg in a lab with your partner’s sperm and then implanting it into your uterus. It’s a treatment option doctors usually reserve for the following scenarios:

• Women with stage three or four endometriosis
• Women who’ve used pursued other fertility treatments and still haven’t conceived

While this can be a more invasive approach to conceiving, the success rates with IVF to become pregnant with endometriosis are very promising. One study noted that 56% of women with stage three and four endometriosis were able to get pregnant after 1 to 4 rounds of IVF. Additionally, IVF can give you and your partner the opportunity to choose the gender of your baby.

Get to Know Your Baby-To-Be with SneakPeek

Trying for a baby while managing endometriosis can be immensely challenging, which can make positive news from your pregnancy test feel even more momentous. Once your new reality has settled in, you’ll probably be pondering some very important questions—namely, are you having a little boy or girl?

The SneakPeak Early Gender Blood Test makes it possible to discover your baby’s gender as early as 6 weeks into your pregnancy. As the #1 OBGYN-recommended at-home gender test, SneakPeek is clinically proven to produce over 99% accurate¹ results from the comfort of your own home. SneakPeek is also here to answer any of your pregnancy-related questions, such as if you can get pregnant on your period, how to get pregnant fast, how to increase your chances of twins, and much more.

No matter what obstacles you overcame to start the path to motherhood, you deserve to welcome your new baby on your own terms. Join over 1 million moms who’ve used SneakPeek Test and start getting to know your new little one today.<!–

This post has been reviewed for accuracy by the following medical professional:

Katie Smith, MSN, APRN, CNM

Certified Nurse midwife and mom to 6 kiddos ranging in age from 3 months to 21… I own my own birthing center – Birth Your Way Midwifery and Women’s Wellness Center, which is the first and only one in Bay County, Florida. I love the beach, swimming, horseback riding, and reading.

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