How to get pregnant if you have endometriosis
Endometriosisdoesn't mean you can't get pregnant, but it can increase your chances of infertility.
- As many as 20%-25% of women with endometriosis are asymptomatic.
- Women with endometriosis who are trying to conceive should see a reproductive endocrinologist.
- This article was medically reviewed by G. Thomas Ruiz, MD, OB/GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California and Kecia Gaither, MD MPH FACOG, Director of Perinatal Services at NYC
Endometriosis affects one in 10 reproductive-aged individuals — that's an estimated 200 million people worldwide.
While 30% to 50% of those with endometriosis struggle with infertility, that doesn't necessarily mean you should give up hope.
"Many women, myself included, have gotten pregnant with endometriosis," says Janelle Luk, MD, FACOG, Medical Director at Generation Next Fertility. "Endometriosis doesn't mean you can't get pregnant on your own, however, it can increase your chances of infertility.
If you have endometriosis and are interested in starting a family, here are some helpful steps you and your partner can take.
What is endometriosis?
Let's start with the basics. Endometriosis is when endometrial-like tissue, also known as implants, grows outside of the uterus resulting in chronic inflammation, scar tissue, and adhesions.
"Endometriosis is a highly variant disorder from mild to severe presentation," says Fahimeh Sasan, MD, founding physician and OB-GYN of Kindbody. "Depending on the severity of the disease and extent of pelvic and abdominal organ involvement, the level of pain will vary from woman to woman."
It's also important to note that the amount of pain one feels does not necessarily correlate to the severity of the condition. Here are the four stages of endometriosis that describe the severity of a patient's condition:
- Stage I endometriosis. Stage I endometriosis is considered "minimal". During this stage, implants are small, shallow, and few in number.
- Stage II endometriosis. Stage II endometriosis is considered "mild". During this stage, doctors may find more implants that are deeper than the implants found in Stage I patients.
- Stage III endometriosis. Stage III endometriosis is considered "moderate". During this stage, patients may experience a combination of deep implants and endometrial cysts on one ovary. Stage III patients may also have filmy adhesions or thin bands of tissue that have bound their organs together.
- Stage IV endometriosis. Stage IV endometriosis is considered "severe". During this stage, patients will have deep implants, large cysts, and several dense adhesions throughout their pelvic region.
Endometriosis is persistent and can cause the tissue to grow where it doesn't belong, including the intestines, rectum, and bladder. The most common sites of endometriosis include:
- Fallopian tubes
- Ligaments that support the uterus
- Posterior cul-de-sac (i.e. the space between the uterus and the rectum)
- Anterior cul-de-sac (i.e. the space between the uterus and the bladder)
- The lining of the pelvic cavity
Because every woman's body is different, not every person will experience the same symptoms. In fact, 20%-25% of women with endometriosis are asymptomatic. Some of the common symptoms of endometriosis include:
- Debilitating pain in the lower back or abdomen
- Abnormal or heavy menstrual flow
- Pain during intercourse
- Pain with urination during menstrual periods
- Pain with bowel movements during menstrual periods
- Leg pain
- Chronic fatigue
- Gastrointestinal problems, such as constipation, diarrhea, and nausea
Can you get pregnant with endometriosis?
Endometriosis is considered one of the three major causes of female infertility — even so, it's not impossible for a woman with endometriosis to get pregnant.
"It's definitely possible to get pregnant with endometriosis," says Barry Witt, MD, Director of WINFertility and Greenwich Fertility & IVF Center. "Some will conceive with no problem, while others will require treatment in order to conceive."
How endometriosis affects fertility is unclear, but researchers believe that scar tissue has a lot to do with it.
"Some severe cases of endometriosis result in significant scarring around the ovaries and fallopian tubes — this can either block the tubes or make it difficult for them to function normally," Witt tells Insider. "Multiple surgeries for endometriosis can be associated with scarring and can affect ovarian function."
Endometriosis can also damage a woman's egg or a man's sperm, ultimately preventing
Laparoscopy is the only way to confirm an endometriosis diagnosis. Pregnancy can still occur, depending on the severity of endometriosis found at the time of laparoscopy. According to Brigham Women's Hospital, pregnancy rates may improve if Stage I or II endometriosis is removed surgically.
"I was diagnosed with Stage IV Endometriosis and wound up losing both of my Fallopian tubes," says Melissa Randazzo, a mother of two who has endometriosis. "After two rounds of IVF, I was able to get pregnant with my first little miracle, Gaspare." She later gave birth to her daughter, Lucy.
How to get pregnant with endometriosis
If you have endometriosis and are interested in starting a family, it may help to speak with your endometriosis specialist or OB-GYN first. This is particularly true for women who have had multiple surgeries for endometriosis.
"Women with endometriosis who are trying to conceive should see a reproductive endocrinologist," says Witt. "A fertility specialist can evaluate the woman's individual case based on her symptoms, ultrasound findings, age, and other fertility factors in order to determine the best course of treatment."
A reproductive endocrinologist can also conduct blood tests, such as an anti-mullerian hormone (AMH) test. This test can help determine a patient's remaining egg supply or ovarian reserve.
Endometriosis isn't a one-size-fits-all condition, but taking the time to speak with your doctor, limiting your intake of inflammatory foods, and engaging in moderate physical activity can improve your chances of natural conception.
If after six months you and your partner are unsuccessful conceiving naturally, you may want to consider an endometriosis-related infertility treatment option, like the ones listed below.
Superovulation and Intrauterine Insemination (SO-IUI)
Superovulation and intrauterine insemination (SO-IUI) is a viable option for women who have normal fallopian tubes.
SO-IUI is a two-step process that combines either injectable or oral fertility medication and sperm insemination.
Once the patient's follicles are ready to ovulate, her partner will be asked to provide a fresh sperm sample to the doctor or clinic. This sample is then prepared, "washed," and inserted into the woman's uterus via a catheter. In some cases, this sample may be provided by a donor.
In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is a complex combination of procedures used to help with fertility. One IVF cycle involves five steps:
- Ovarian stimulation. If using your own eggs, your doctor may recommend taking a variety of medications, including synthetic hormones to stimulate the ovaries, one or more medications to prevent premature ovulation, and progesterone supplements to prep the lining of the uterus for implantation.
- Egg retrieval. To determine whether eggs are ready for retrieval, your doctor will perform a vaginal ultrasound and a blood test. Once cleared for retrieval, patients are sedated and given a transvaginal ultrasound. During the ultrasound, a thin needle is inserted into an ultrasound guide — this needle is inserted into the follicles to retrieve the eggs. The eggs are then removed from the follicles. Mature eggs are collected and placed in a nutritive liquid and incubated.
- Sperm retrieval. If using your partner's sperm, he'll need to provide a semen sample via masturbation the morning of egg retrieval. Donor sperm can also be used.
- Fertilization. Fertilization can happen in one of two ways: Conventional insemination or intracytoplasmic sperm injection (ICSI). During conventional insemination, healthy sperm and mature eggs are combined in a petri-dish and incubated overnight. ICSI involves injecting one single healthy sperm into each mature egg.
- Embryo transfer. Two-to-five days following egg retrieval, you'll go through the embryo transfer process. During this procedure, the doctor will insert a catheter into the vagina, through the cervix, and into the uterus. Using a syringe, the doctor places one or more embryos into the uterus. If successful, implantation will occur six-to-10 days following egg retrieval.
"If there is tubal involvement, such as a blocked tube or scarring in the tube, the treatment typically recommended is IVF, because with IVF you can bypass the tubes completely," says Dori Gelfman, RN, infertility specialist and Community Manager at Fruitful Fertility. "By retrieving the eggs from the ovaries, fertilizing them, and placing them directly in the uterus, you have created a detour where the tubes are no longer needed."
Although most women with endometriosis who get pregnant have normal pregnancies and deliveries, women with endometriosis have a higher risk of:
- Preterm birth
- Placenta previa
- Cesarean delivery
Although temporary, some women with endometriosis may experience relief with pregnancy due to an increase of progesterone.
"Pregnancy may actually alleviate some of the symptoms experienced for patients with endometriosis," says Luk. "For approximately nine months, the patient may experience minimal pain related to the endometriosis."
Women with endometriosis can get pregnant, naturally or with the help of fertility treatments, depending on the severity of their condition, age, and overall health.
Endometriosis is an intrusive, incurable, chronic illness. In addition to causing debilitating pain, endometriosis may affect one's mental health, social relationships, and sexual functioning.
"Missing work and school aren't uncommon in women with endometriosis," says Fernando Mariz, MD, a New York City gynecologist and obstetrician. "Between the bloating, pain, and general malaise, completing normal tasks can be almost impossible."
If you have endometriosis, being proactive and advocating for your reproductive health is key for a healthy pregnancy. This may include lifestyle changes or consulting with a fertility specialist about medical interventions.
"I recommend advocating for yourself and being proactive with any treatment you need while you are still young, even before you are considering pregnancy," Luk tells Insider.
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