Endometriosis and Pregnancy: What to Expect when TTC

According to John Hopkins Medicine, approximately 2-10% of women ages 25-40 are affected by endometriosis, which can wreak havoc on the reproductive system and cause a lot of pain in the process.

For the vast majority of cases, hormonal birth control does the trick to ease symptoms and suppress the spread of endometriosis. However, if you are trying to conceive (TTC), you may need to explore other solutions. 

In this article, we’ll cover everything you need to know about endometriosis, how it affects your ability to get pregnant, and potential treatment options available. We’ll also discuss certain risk factors to be aware of if you are pregnant with endometriosis. 

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows in patches outside of the uterus where it is not supposed to. Specifically, these patches can grow around the ovaries, on the fallopian tubes, and on the outer surface of the uterus. In rare cases, it can also grow around the intestines, bladder, rectum, cervix, vagina, and vulva. 

Those with endometriosis may experience heavy bleeding and severe cramping before and during their period. Other common symptoms include painful intercourse, gastrointestinal problems around the time of menstruation, and difficulties with getting pregnant. 

Can you get pregnant if you have endometriosis?

Yes. It is still possible to get pregnant even if you have endometriosis. In fact, the pregnancy charity Tommy’s estimates that among women with mild to moderate endometriosis, approximately 70% of them will conceive without needing treatment. 

 

Endometriosis and pregnancy

How does endometriosis affect pregnancy?

Endometriosis can have a negative impact on your ability to get pregnant. This is demonstrated by the fact that approximately 30-50% of women struggling with infertility have endometriosis. 

Even though the reasons why are not fully understood by medical researchers and doctors, there are few generally accepted explanations. These include:

• The buildup of excess tissue around the fallopian tubes can interrupt the travel of a fertilized egg from the ovaries to the uterus. 
• High levels of inflammation can complicate reproductive functioning. 
• Endometriosis may also reduce ovarian reserve, which can have an impact on egg quantity. 
• Symptoms of endometriosis can make intercourse painful, resulting in less frequent sex. 

Combined, all of these complications due to endometriosis can impede a couple’s efforts to get pregnant.  

Are there any risks involved with getting pregnant with endometriosis?

Although many individuals with endometriosis go on to have successful pregnancies, there are still potential pregnancy risks and complications to be aware of. This includes increased risk of:

• Miscarriage
• Preterm delivery
• Ectopic pregnancy
• Placenta praevia
• Postpartum hemorrhage 

However, it’s important to bear in mind that the severity of these risks will be unique to each individual. If you have endometriosis and are concerned about the health of your pregnancy, speak with your doctor and they can provide the best advice tailored to your situation.  

What are your chances of getting pregnant if you have endometriosis?

Your chances of getting pregnant with endometriosis will depend on a number of factors including your age, past pregnancies, ovarian reserve, and how severe your endometriosis is. However, for the vast majority of cases, the outlook is positive. 

For example, in mild to moderate cases, an estimated 70% of individuals will be able to get pregnant without medical intervention. Public health experts at Jean Hailes for Women’s Health also estimate that among severe cases, approximately 75% will be able to conceive, with a third of these cases likely requiring help from in vitro fertilization (IVF).

One practical way that doctors may assess your ability to get pregnant is by using the Endometriosis Fertility Index (EFI). This index is designed to be used after laparoscopic surgery in order to predict a patient’s chances of natural conception following the procedure. This tool is widely considered as the best and most accurate way to assess the likelihood of potential pregnancy in patients with endometriosis. 

How can you improve your chances?

Lifestyle changes

If you have endometriosis, it’s important to understand that many of the symptoms and side effects are out of your control. However, there are still certain lifestyle factors that you can control to keep your hormones balanced and overall chances of conception high. 

This includes: 

• Maintaining a healthy weight. 
• Engaging in at least 150 minutes of mild to moderate-intensity exercise each week. 
• Eating a healthy pre-pregnancy diet.
• Limiting caffeine intake. 
• Avoiding potentially harmful substances such as alcohol, drugs, and tobacco.
• Reducing overall stress levels. 

By keeping all of these factors in balance, you will maximize your fertility and chances of getting pregnant.  

Reducing inflammation and pain

Inflammation due to endometriosis can cause extreme pain, which often leads to more infrequent sex. One way to reduce this inflammation and ease pain is by taking an over-the-counter non-steroidal anti-inflammatory medication – also known as “NSAIDs”. The most common types of NSAIDs are ibuprofen, naproxen, and aspirin. 

Another way to reduce inflammation is by following an endometriosis-friendly diet. Why? Because your body uses food to its advantage to fight inflammation and keep hormone levels in check. If you’ve never followed an anti-inflammatory diet before, here is a brief list of which foods you should eat and avoid. 

• Foods to eat: fruits, vegetables, beans, whole grains, nuts, seeds, avocados, olive oil,  fish, poultry, and red meat (in moderation). 
• Foods to avoid: processed foods, sugar, fatty meats, caffeine, and alcohol. 

Laparoscopic surgery

In cases where lifestyle changes and pain management doesn’t seem to help, laparoscopic surgery may be necessary. The aim of this minimally invasive procedure, often called a “keyhole surgery”, is to remove excess tissue around the ovaries, fallopian tubes, and general pelvic area. Research shows that this can then help to improve chances of natural conception. 

Assisted reproductive technology (ART)

If lifestyle changes and laparoscopic surgery still doesn’t help you conceive, it’s worth exploring your options for assisted reproductive technology (ART). Depending on your age, medical history, and severity of endometriosis, your doctor may recommend IUI (intrauterine insemination) or IVF (in vitro fertilization) to help you get pregnant. 

Can endometriosis impact fertility?

Yes. Endometriosis can negatively impact fertility in a number of ways. The American Society for Reproductive Medicine lists the following reasons why this is the case:

• Inflammation and distortion of the pelvic structure. 
• Fallopian tube scarring. 
• Weakened immune system. 
• Altered egg quality due to hormonal environment. 

Treating endometriosis

Even though there is no cure for endometriosis, it is still possible to treat the symptoms in order to reduce pain and achieve your fertility goals. 

To get started, consider the following treatment options:

• Balancing your overall health by exercising regularly, reducing stress, and maintaining healthy eating patterns. 
• Reducing inflammation with over-the-counter NSAIDs and an anti-inflammatory diet. 
• Having excess tissue removed through laparoscopic surgery. 

If you are not trying to conceive, hormonal birth control can also help to alleviate symptoms and limit excess tissue growth. If you are trying to conceive, it may also be worth exploring your options for ART with a fertility specialist. 

FAQs about endometriosis and pregnancy

Can endometriosis cause miscarriage?

Endometriosis does not directly cause miscarriage. However, research shows that the increased inflammation caused by endometriosis can be a risk factor for miscarriage (although this is not necessarily true in cases of in-vitro fertilization). 

Does endometriosis mean high-risk pregnancy?

Yes. If you have endometriosis and you are pregnant, this means that your pregnancy is at a greater risk of experiencing complications. 

A meta-analysis published in 2017 found that pregnant women with endometriosis are at a higher risk of experiencing preterm birth, miscarriage, placenta previa, and requiring a cesarean delivery. They are also more likely to give birth to low birth-weight babies. 

If you have endometriosis and are currently pregnant, don’t panic. It just means that your doctor will want to monitor your pregnancy more closely. 

Should endometriosis be treated differently if you’re TTC?

Yes. If you are TTC, your treatment options for endometriosis will be different. Hormonal birth control is one of the most common ways to alleviate symptoms of endometriosis, which is not an option if you are looking to plan a pregnancy. 

Instead, your doctor may encourage you to treat your symptoms by following an anti-inflammatory diet or undergoing laparoscopic surgery. If neither of these two treatments work, it’s also possible to pursue fertility treatments such as IVF or IUI.