Can Endometriosis Cause Infertility?

Endometriosis is a relatively common condition that affects up to 10% of all people in the United States. It causes abdominal pain, especially during the menstrual cycle or sex.

As endometriosis progresses, it can affect fertility. About 30–50% of those having trouble becoming pregnant have endometriosis. This condition causes physical and hormonal changes that may make it difficult to become pregnant. 

This article will discuss endometriosis, how it affects fertility, and what to do about it. 

How Does Endometriosis Cause Infertility?

Endometriosis causes tissue to build up outside the uterus, causing inflammation, scarring, and cysts. It often builds up around the ovaries or fallopian tubes (the tube where an egg travels to the uterus).

They can become blocked when adhesions form in or around the fallopian tubes. This prevents the egg from traveling through the tube during ovulation, lowering the chances of becoming pregnant each month. 

Endometriosis causes the following changes that may affect fertility:

• Changed anatomy of the pelvis
• Scar tissue (adhesions)
• Scarred fallopian tubes
• Inflammation in the pelvic structures 
• Immune system changes
• Hormonal changes 
• Impaired implantation
• Different egg quality 

Infertility and Endometriosis Types

Endometriosis is broken down into stages to understand how severe the condition is. To determine the stage, a healthcare provider performs a laparoscopy to visualize the amount and location of endometrial tissue in the body. 

Endometriosis stages include:

• Stage 1: Minimal 
• Stage 2: Mild
• Stage 3: Moderate
• Stage 4: Severe

People with stage 4 endometriosis are more likely to experience scarring, blocked fallopian tubes, or damaged ovaries, and report the most difficulty getting pregnant. 

Diagnosing Infertility

Many people with endometriosis can become pregnant, and it is safe to try to conceive. Once you have been trying for six months, talk with a healthcare provider. People who do not have endometriosis and are considered low-risk are usually advised to try to conceive for one year before seeing their provider. 

To understand the cause of your infertility, your provider may recommend several tests. They may recommend a laparoscopy to determine how advanced your case of endometriosis is. This could determine if you have scarring or blockages around the fallopian tubes. 

Other fertility tests include blood tests to measure hormone levels and thyroid function and imaging studies to evaluate the anatomy of your organs.

Your health insurance may cover infertility testing. Consider calling your insurance company or hospital billing department to understand how much of the evaluation it covers. 

Endometriosis Fertility Index (EFI)

The endometriosis fertility index (EFI) is a tool used to predict a person’s likelihood of becoming pregnant after having endometriosis surgery. It can help to determine when to use fertility treatments as well.

The EFI is based on historical and surgical factors. Historical factors include your age, how long you have experienced infertility, and any past pregnancies. Surgical factors include the extent and location of endometriosis tissue found during surgery. The higher the score on the EFI, the greater the chances of conceiving.

Fertility Treatment for Those With Endometriosis

Fortunately, there are effective treatment options for people with endometriosis who wish to become pregnant. The treatment plan depends on the extent and location of the endometriosis tissue and your overall health. 

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is often recommended for people with mild to moderate endometriosis who are having trouble becoming pregnant. IUI is an assisted reproductive technology (ART) that uses a thin tube (catheter) to place sperm directly into the uterus. This may be helpful for people who have scar tissue from endometriosis. 

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) may be recommended for people with moderate to severe endometriosis and if IUI is unsuccessful. IVF is a medical procedure that combines the sperm and egg outside of the body. The fertilized egg is then implanted directly into the uterus. 

Endometriosis Surgery

Endometriosis surgery may be helpful for those trying to become pregnant with mild to moderate endometriosis. Surgery destroys or removes endometriosis tissue. This can help to open up the fallopian tubes if scar tissue is blocking them.

For people with moderate to severe endometriosis, surgery may remove any large pieces of endometriosis tissue and restore the normal anatomy of the pelvis. Surgery may be an effective fertility treatment on its own or may be combined with IUI or IVF.

Pain Relief While Trying to Conceive

A common endometriosis symptom is pain with sex. This is especially burdensome when trying to become pregnant. Talk with a healthcare provider about options for pain relief. Because endometriosis tissue causes inflammation in the pelvis, non-steroidal anti-inflammatory drugs (NSAIDs) are often helpful. Talk with your provider if your pain is not controlled with over-the-counter options.

Improving Your Chances of Conceiving

Many people with endometriosis can become pregnant and carry a healthy pregnancy on their own. Though you may need medical help in the future, there are steps that you can take now to improve your chances of conceiving with endometriosis.

Endometriosis tissue grows and thickens in response to estrogen, so finding ways to regulate the amount of estrogen in your body may be helpful. To lower your estrogen levels, consider the following lifestyle changes:

• Exercise regularly: This helps you to maintain a healthy weight, which improves endometriosis symptoms. It can also decrease the amount of estrogen circulating in your blood.
• Limit caffeine: Large amounts of caffeine can raise estrogen levels, so consider cutting back on your coffee, soda, or tea consumption. 
• Avoid alcohol: You may already avoid alcohol as you try to conceive. This could help your endometriosis symptoms because drinking alcohol raises estrogen levels.

The Best Age to Get Pregnant With Endometriosis

A person’s natural fertility starts to gradually decline in their 30s. It is easier to become pregnant in your 20s than in your 30s or 40s. Discuss your options with a healthcare provider if you are trying to conceive after 35.

Pregnancy Complications With Endometriosis

Most people with endometriosis who become pregnant have healthy pregnancies and babies. However, having endometriosis may raise the risk of certain pregnancy complications, including: 

• High blood pressure: People with endometriosis are at a higher risk of having high blood pressure (hypertension) during pregnancy, which can cause preeclampsia. This serious complication leads to preterm labor.
• Gestational diabetes: The rate of gestational diabetes is up to 40% higher in pregnant people with endometriosis than those without it. 
• Ectopic pregnancy: An ectopic pregnancy occurs when a fertilized egg implants outside the uterus. People with endometriosis are more likely to experience an ectopic pregnancy. 
• Miscarriage: Pregnant people with endometriosis are up to 60% more likely to experience miscarriage than people without this condition. People with moderate to severe endometriosis are more likely to miscarry than those with mild disease. 
• Low birth weight: Babies of people with endometriosis are likelier to be born at a low birth weight, which may raise the risk of health problems after birth. 
  

When to Seek Care

Endometriosis is one of the most common causes of infertility but is treatable. Talk with a healthcare provider if you have endometriosis and have been trying to conceive for at least six months. If you are 35 or older, talk with a provider when you are ready to start trying. 

Summary

In addition to pain and swelling, endometriosis adhesions can make it more difficult to become pregnant. Up to 30–50% of people experiencing infertility have endometriosis. Fortunately, endometriosis and infertility are treatable. Depending on the stage of the disease, a healthcare provider may recommend medications, endometriosis surgery, IUI, or IVF to manage endometriosis and increase your odds of conceiving.