Endometriosis is a severe inflammatory condition occurring in 5-10% of women of reproductive age (190 million globally), causing tissue similar to the uterine lining to grow outside the uterus. While this condition can impact fertility, it’s important to know that many women with endometriosis successfully conceive. With advances in medical treatments and fertility options, there’s hope for those struggling to get pregnant.
What is endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside it, often leading to pain. It commonly affects the ovaries, fallopian tubes, and the pelvic lining. In rare cases, this tissue can even spread beyond the pelvic area.
Like the uterine lining, this tissue thickens, breaks down, and bleeds with each menstrual cycle. However, since it’s in the wrong place, it doesn’t leave the body. When it involves the ovaries, cysts known as endometriomas can develop. This may irritate nearby tissue, leading to scar formation and adhesions, which cause pelvic organs to stick together.
Endometriosis can result in pain, particularly during periods, and may lead to fertility issues.
What are the symptoms of endometriosis?
According to the NHS, endometriosis typically grows around the womb, including the ovaries and fallopian tubes, but it can also affect the bladder and bowel. Symptoms occur when endometriosis patches break down and bleed during periods but cannot leave the body.
Some common symptoms during your period include:
- Severe pain that disrupts daily activities
- Heavy bleeding, requiring frequent pad or tampon changes
- Pain when passing urine or during bowel movements
Other symptoms throughout the cycle can include:
- Lower abdominal and back pain
- Pain during or after sex
- Extreme fatigue
Endometriosis may also lead to difficulty getting pregnant and impact mood or anxiety levels.
Does endometriosis affect fertility?
Endometriosis is a common gynaecological condition that doesn’t always lead to infertility or pain. According to the charity, Endometriosis UK, many people with endometriosis can conceive naturally without medical assistance. Mild cases are more common, and most individuals will have no trouble conceiving. However, as the severity of the condition increases, scar tissue (adhesions) may develop, which can reduce the chances of conception by trapping the egg and/or preventing it from travelling through the fallopian tube. While there is a known link between endometriosis and infertility, the exact cause remains unclear. Even in severe cases, natural conception is still possible.
What are the chances of getting pregnant if you have endometriosis?
Many people with endometriosis can conceive without medical intervention, but the condition can reduce the chances of conception, particularly in moderate to severe cases.
Anatomical distortion and adhesions caused by endometriosis can impact fertility, and even those with minimal to mild endometriosis may experience slightly lower chances of conceiving. Studies have shown that approximately 50% of women with minimal to mild endometriosis will be able to conceive without treatment, whereas only 25% of those with moderate disease will conceive spontaneously, with very few spontaneous conceptions occurring in cases of severe disease.
That said, research has proved that with medical assistance, around 60-70% of individuals with endometriosis overall become pregnant. To illustrate this, out of 100 individuals without endometriosis trying for a baby, 84 will be pregnant after one year. However, for those with severe endometriosis, only 25 will conceive within the same period.
What should you do if you have endometriosis and are struggling to get pregnant?
If you have endometriosis and are having difficulty getting pregnant, it’s important to know that you’re not alone and that there are supportive options available. If you’ve been trying to conceive for six months or longer, consider seeing a doctor who can evaluate your situation and guide you through the next steps. They may refer you to a fertility specialist, who can offer tailored treatment options, such as hormone therapy, fertility medications, or assisted reproductive technologies like in vitro fertilisation (IVF). Taking this proactive approach can help manage your symptoms and improve your chances of conception, bringing you closer to your goal of starting a family.
Are there treatments for endometriosis-related infertility?
Just like PCOS, endometriosis treatment can be complex, and sadly, there is no cure. However, several treatments can help manage symptoms and improve fertility:
Hormone-inhibiting treatment: Aimed at limiting oestrogen production, this can reduce endometrial tissue growth.
Surgery: In some cases, your doctor might recommend:
- Laparoscopic surgery (keyhole surgery): Uses small incisions to burn away endometriotic tissue.
- Hysterectomy: Removal of the womb, only recommended in severe cases due to its impact on fertility.
Fertility treatment: If conception is difficult, you may be referred to a reproductive endocrinologist. Treatment options can include in vitro fertilisation (IVF).
How else can you improve your chances of conceiving with endometriosis?
There are several lifestyle changes that can improve help optimise the chances of conceiving generally. First and foremost, maintaining a healthy weight through a balanced diet rich in antioxidants, omega-3 fatty acids, and anti-inflammatory foods helps support reproductive health. Regular exercise can also reduce inflammation and stress, both of which impact fertility. Of course, quitting smoking and limiting alcohol consumption are all crucial steps when trying to conceive.
As stress is associated with endometriosis, techniques like yoga, meditation, or counselling can also be beneficial. If you have endometriosis and are struggling to get pregnant, don’t lose hope – advances in reproductive medicine have greatly improved outcomes for women with endometriosis. While the journey may be challenging, remember that with the right support and treatment, pregnancy is often achievable. Stay positive, take care of your overall health, and work closely with your healthcare team to explore all available options.
References:
National Health Service (2022) Endometriosis, NHS. Available at: https://www.nhs.uk/conditions/endometriosis/.
Endometriosis, Fertility and Pregnancy (no date). Available at: https://www.endometriosis-uk.org/sites/default/files/2023-02/Endometriosis%20UK%20-%20Endometriosis%2C%20Fertility%20and%20Pregnancy%20Jan%202023.pdf.
Olive DL, Stohs GF, Metzger DA, Franklin RR. Expectant management and hydrotubations in the treatment of endometriosis-associated infertility. Fertil Steril. 1985; 44: 35–41.
