What to Know About Endometriosis and Pregnancy

Endometriosis is a condition where tissue that is similar to the kind found inside the uterus (called the endometrium) grows outside of it. This condition can make it difficult to get or stay pregnant. A study found that the monthly rate of pregnancy for fertile people is about 20%, and this rate drops to about 2% to 10% in people with endometriosis.

Endometriosis can affect fertility, gestation, and recovery after childbirth. However, each person’s case is different. Some people with endometriosis can still have a successful pregnancy with few complications for them or their baby. If you have endometriosis and are pregnant, your healthcare team will keep a close eye on your and your baby’s health.

a woman experiencing stomach pain while lying down on a sofa at home
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Endometriosis and Fertility

It’s been estimated that infertility affects 30% to 50% of women with endometriosis. However, just because a person is living with endometriosis doesn’t mean that they are infertile. Many women who have mild endometriosis can get pregnant without needing medical interventions.

Endometriosis can cause inflammation and scarring in the pelvis. Experts believe that the inflammation is what makes it difficult for the sperm and egg to come together or for the embryo to implant in the uterus. In later stages of the disease, the scarring can cause structural changes like kinks in the fallopian tubes and prevent the egg from becoming fertilized.

If you are living with endometriosis and having difficulty getting pregnant, talk to your doctor. Your plan of action depends on your age, how long you’ve been trying to get pregnant, and how advanced your condition is.

Endometriosis Doctor Discussion Guide

woman doctor discussion guide

Your doctor may recommend the following treatment options:

  • Surgery: Removing endometrial lesions through laparoscopic surgery can help manage pain from the disease, and it may boost your chances of getting pregnant. Some evidence has shown that pregnancy rates may improve if stage I or II endometriosis is surgically removed. But repeat surgeries can cause scar tissue to form on the reproductive organs, which could be problematic. Your OB-GYN can help you weigh the pros and cons of surgery.
  • In-vitro fertilization (IVF): Women with and without endometriosis have similar IVF success rates, as long as their ovaries are still capable of producing eggs.

Endometriosis and Gestation

People who have endometriosis normally won’t experience complications during pregnancy. However, it is necessary to check in with your doctor frequently to see how your baby is doing.

Inflammation, damage to the uterus, and hormonal spikes, prevalent during endometriosis, may increase your risk for complications like placenta previa, preterm delivery, and miscarriages

Placenta Previa

Normally, your baby and the placenta grow during pregnancy. The placenta supplies oxygen and nutrition to your growing baby via your blood. In some people, the placenta may lie very low in the uterus and partially or completely cover the opening of the cervix. This is called placenta previa.

Placenta previa can make you more prone to heavy bleeding and placenta abruption—separation of the placenta from the uterus—later in your pregnancy. That’s because when the cervix begins to efface (thin out) and dilate (open up) for labor, blood vessels connecting the placenta to the uterus may tear. This results in severe bleeding during labor and birth.

Studies have found that people who have endometriosis and had surgical treatment for the condition are at higher risk of developing placenta previa. Researchers theorized that this may be because these people have more serious cases of endometriosis.

If the bleeding is light, your healthcare specialist might advise you to reduce your activities. However, if the bleeding is heavy, your doctor will likely recommend a blood transfusion and an immediate C-section at 34 to 36 weeks.

Preterm Delivery

A study found that pregnant people with endometriosis are 1.5 times more likely than others without the condition to have a preterm delivery. Endometriosis has also been associated with a low birth weight.

Both preterm delivery and a low birth weight are linked to short- and long-term complications. Short-term complications can include breathing difficulties, brain hemorrhage, and temperature instability, while long-term complications can include developmental issues and eye problems. The earlier in pregnancy a baby is born, the more likely they are to have health problems.

Ways you could tell of you’re starting labor early are:

  • Pelvic pressure
  • Regular contractions that may or may not hurt
  • Bloody or mucus-filled vaginal discharge

If you notice any of these signs, talk to your doctor immediately.

Your baby may be healthy enough to go home soon after birth, or they may need to stay in the newborn intensive care unit for special care. Babies are more likely to be allowed to go home if certain criteria are met, including:

  • Weighs at least four pounds
  • Can keep warm on their own without the help of an incubator (a clear plastic bed that helps keep your baby warm)
  • Can breastfeed or bottle-feed
  • Gains weight steadily
  • Can breathe on their own

Your doctor may recommend that you bring your baby to a neonatologist for checkups after you and your baby leave the hospital. A neonatologist is a doctor who specializes in caring for premature babies and children. 

Miscarriage

The rate of miscarriages is higher in people with endometriosis than those without the condition. One analysis found that people living with endometriosis had a 35.8% chance of miscarriages compared to 22% among people who don’t have the condition. However, more research needs to be done to support this finding.

How you get pregnant also seems to have an impact on your risk of having a miscarriage. Research has found that the rate of miscarriage among people with endometriosis who became pregnant through IVF was similar to that among people who don’t have the condition.

Another study found that the miscarriage rate is higher among people who have endometriosis and spontaneous pregnancies.

It’s important to note that everyone’s pregnancy is different and having endometriosis doesn’t necessarily mean you will be more likely to have a miscarriage. However, you should learn what the symptoms of a miscarriage are, so you can seek medical attention early. They may include:

  • Low back pain
  • Bleeding
  • Stomach cramps
  • Passage of tissue

Endometriosis and Postpartum

Impact on Recovery

After delivery, you may visit your doctor to discuss the various options of treating the endometriosis. However, treatment is not the final stop in all patients.

Also of note, your physician might give you medications that inhibit ovarian activities, which encourage endometrial growths.

Breastfeeding

People with endometriosis can breastfeed their baby safely. Interestingly, breastfeeding seems to have a protective effect over someone who doesn’t already have the condition down the road.

One study showed that women who breastfeed their children for long periods of time are less likely to develop endometriosis. The researchers hypothesized that this is because regular breastfeeding prevents the release of estrogen in the ovaries, which slows down ovulation and growth of the endometrium.

Summary

Endometriosis may make it more difficult for you to get pregnant. If you have early-stage endometriosis, surgery may help improve your condition and increase your chances of conceiving. For others, fertility treatments like IVF may be recommended. Endometriosis has also been associated with complications like placenta previa, preterm baby, and miscarriages. However, by working closely with your healthcare team, you can help ensure you and your baby are healthy throughout this journey.

Frequently Asked Questions

How do you get pregnant naturally with endometriosis?

Even though endometriosis may affect your chances of getting pregnant, most women with mild endometriosis are not infertile. For some people with endometriosis, surgery may increase the chances of pregnancy. However, for others with more severe disease who do not get pregnant after six to 12 months, IVF is recommended.

How do you deal with endometriosis pain while trying to get pregnant?

To alleviate the discomfort, you could try to have surgical treatment or start an exercise program to cope with the pain. You can also ask your doctor which pain medications are safe for you to use.

What should you ask your doctor about endometriosis and pregnancy?

You can talk to your doctor about your condition and the best plan to get pregnant. Since that may look different depending on how severe your condition is, it’s most appropriate to seek your doctor’s advice. You may want to ask if surgery is suitable for you because it can increase your chances of getting pregnant.

What are the chances of getting pregnant after endometriosis surgery?

A study showed that the natural conception rate after 12 months post-laparoscopic surgery in infertile women was 41.9%. If you don’t get pregnant within six to 12 months post-surgery, your doctor may recommend fertility treatments such as IVF.

A Word From Verywell

Living with endometriosis has its own challenges since it can be stressful for you. It’s important to remember that it’s still possible to become pregnant and have a successful pregnancy.

Getting pregnant may seem tough, but it is possible, and you can ask your doctor for help if you are experiencing infertility. As you go through your pregnancy, keep track of any changes in your health or new symptoms so that your doctor can offer help where necessary.

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15 Sources
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  1. Fadhlaoui A, Bouquet de la Jolinière J, Feki A. Endometriosis and infertility: how and when to treat? Front Surg. 2014;1:24.

  2. Cleveland Clinic. Can I get pregnant if I have endometriosis?

  3. Brigham and Women’s Hospital. Endometriosis and fertility.

  4. Dong X, Liao X, Wang R, Zhang H. The impact of endometriosis on IVF/ICSI outcomes. Int J Clin Exp Pathol. 2013;6(9):1911-1918.

  5. March of Dimes. Placenta previa. Updated January 2013.

  6. Miura M, Ushida T, Imai K, et al. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth. 2019;19(1):373. doi:10.1186/s12884-019-2514-1

  7. Kim SG, Seo HG, Kim YS. Primiparous singleton women with endometriosis have an increased risk of preterm birth: meta-analyses. Obstet Gynecol Sci. 2017;60(3):283-288. doi:10.5468/ogs.2017.60.3.283

  8. Bruun MR, Arendt LH, Forman A, Ramlau-Hansen CH. Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018;97(9):1073-1090. doi:10.1111/aogs.13364

  9. March of Dimes. Premature babies. Updated October 2019.

  10. Schwartz ASK, Wölfler MM, Mitter V, et al. Endometriosis, especially mild disease: a risk factor for miscarriages. Fertility and Sterility. 2017;108(5):806-814.e2.

  11. Yang P, Wang Y, Wu Z, Pan N, Yan L, Ma C. Risk of miscarriage in women with endometriosis undergoing IVF fresh cycles: a retrospective cohort study. Reprod Biol Endocrinol. 2019;17(1):21. doi:10.1186/s12958-019-0463-1

  12. Minebois H, De Souza A, Mezan de Malartic C, et al. Endométriose et fausse couche spontanée. Méta-analyse et revue systématique de la littérature [Endometriosis and miscarriage. Systematic review]. Gynecol Obstet Fertil Senol. 2017;45(7-8):393-399. doi:10.1016/j.gofs.2017.06.003

  13. Selçuk İ, Bozdağ G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc. 2013;14(2):98-103.

  14. Farland LV, Eliassen AH, Tamimi RM, Spiegelman D, Michels KB, Missmer SA. History of breast feeding and risk of incident endometriosis: prospective cohort study. BMJ. 2017 Aug 29;358:j3778. doi:10.1136/bmj.j3778

  15. Lee HJ, Lee JE, Ku SY, et al. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. Clin Exp Reprod Med. 2013;40(1):29-32. doi:10.5653/cerm.2013.40.1.29

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