How to Get Pregnant If You Have Endometriosis

You can get pregnant with endometriosis, though it may not be easy. In fact, up to half of those with endometriosis have trouble conceiving.

Endometriosis causes abnormal tissue to grow around your reproductive organs, which can affect your ability to get pregnant. Scar tissue caused by endometriosis can also make it harder to conceive.

While there are medical options if you have endometriosis and want to get pregnant, they are often complex and costly with varying degrees of success.

Why Endometriosis May Cause Difficulty Getting Pregnant
 Verywell / Colleen Tighe

This article discusses the causes and risks of infertility in people with endometriosis and what can be done to help if you are diagnosed with this common and often painful disorder.

How Does Endometriosis Affect Pregnancy?

Endometriosis can make it harder to get pregnant because it causes tissue that usually only grows inside the uterus (womb) to grow in other places. The exact reason for infertility in people with endometriosis can vary, however. In some cases, multiple causes are involved. Some common ones include:

  • Ovarian cysts: Endometriosis can spread to the ovaries and produce cysts. Unlike other ovarian cysts, these cysts—called endometriomas—can cause infertility by either blocking the release of an egg from its follicle or the passage of the egg into the fallopian tube.
  • Adhesions: The overgrowth of tissues can cause adhesions. Adhesions are scars that form between tissues inside the body and cause them to stick together. This can prevent an egg from making its way from the fallopian tube to the uterus, or sperm from reaching the egg.
  • Egg quality: Studies have found that endometriosis affects the quality of eggs in the ovary.
  • Pain during sex: Pain during sex is one of the more common symptoms of endometriosis and one that can reduce the odds of getting pregnant by reducing your ability to have intercourse. The irony, of course, is that symptoms of endometriosis are often controlled with hormonal birth control, which prevents pregnancy.

Endometriosis also increases the risk of pregnancy loss. Studies have found that women with endometriosis are 60% more likely to have a miscarriage than those without it. No one knows for sure why this happens, since women with milder disease appear to be at greater risk than those with severe disease.

Endometriosis affects 10% to 15% of females of child-bearing age. A 2012 study from Yale reported that 30% to 50% of women with endometriosis are unable to conceive. Even those who are mildly affected are 48% less likely to get pregnant than women who do not have endometriosis.

Because endometriosis does not cause symptoms in up to 25% of cases, many couples who cannot conceive may only realize that endometriosis is involved when they see a fertility doctor.

When symptoms do appear, they may include:

Endometriosis Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Staging and Infertility Risk

During the diagnosis of endometriosis, your doctor may refer to the stage of the disease. Staging is a way to describe the severity of your condition based on the location, amount, and depth of tissue overgrowth. The stages of endometriosis run from stage 1 for the mildest form of the disease to stage 4 for the most severe form.

As a general rule, women with stage 1 or 2 are more likely to conceive than women with stage 3 or 4. But that's not always true.

In some cases, women with stage 1 may have more trouble getting pregnant than someone with stage 3 or 4. The risk depends largely on which organs of the female reproductive system are affected and how.

Where staging does help is with planning. For example, a woman with stage 1 or 2 endometriosis may try to conceive on her own at first, while someone with stage 3 or 4 may proceed directly to fertility treatment.

Trying Natural Pregnancy

If you've been diagnosed with endometriosis, you may wonder if it's worth trying to conceive on your own before seeking treatment. The answer is simple: yes.

Of course, you should speak with a doctor first, but having endometriosis doesn’t mean you can't get pregnant. Many women do, even some whose condition is advanced.

In such cases, most experts advise that you try to conceive naturally for six months (rather than the 12 months recommended for other women). If you don't get pregnant within that timeframe, then you should speak with a fertility specialist.

With that said, some women will go straight to a specialist, especially if they are older. After 35, natural fertility declines. For some, those six months may be better spent under specialist care.

Assisted Treatment Options

The most effective treatment for endometriosis-related infertility depends on your age, the stage of the disease, your infertility risk factors, treatment costs, and personal choice.

Intrauterine Insemination (IUI)

Fertility drugs alone are not typically used in women with endometriosis. They don’t improve pregnancy rates much compared to those who try to conceive naturally.

Instead, intrauterine insemination (IUI) along with fertility drugs is the typical starting point for women with stage 1 or 2 endometriosis. IUI is a procedure where sperm is introduced into the womb during ovulation.

Clomid (clomiphene) and gonadotropin are the fertility drugs commonly used for IUI. Clomid is usually used first as it is less likely to cause multiple births or a potentially serious condition called ovarian hyperstimulation syndrome (OHSS) that causes ovaries to swell.

Studies have shown that, in women with endometriosis, combining IUI with Clomid or gonadotropin triples the odds of getting pregnant compared to natural pregnancy.

In Vitro Fertilization (IVF)

If IUI does not work, the next step is in vitro fertilization (IVF). IVF involves removing eggs and fertilizing them outside of the body, then transferring them into the womb. It provides the best chance of getting pregnant but is also costly and invasive.

IVF is sometimes used as the first-line treatment if a woman is over 35, has stage 3 or 4 disease, or has additional risk factors for infertility (such as low egg quality or quantity).

Studies have shown that the success rate of IVF in women with endometriosis is around 22%, more or less in line with women with other forms of infertility.

IVF is not an option for all couples. Some couples prefer less intensive treatments, while others simply cannot afford the cost of IVF. For these couples, multiple rounds of IUI may be advised as well as adoption or surrogacy.

Surgery and Fertility Rates

The number one reason for endometriosis surgery is to reduce pain symptoms. Beyond pain reduction, surgery may help increase the odds of pregnancy in some—but not all—women.

For women with severe endometriosis, surgery does not appear to improve success rates for IUI or IVF. In fact, repeated surgeries can cause adhesions that make pregnancy more difficult.

On the other hand, some studies suggest that women with stage 2 or 3 endometriosis may have a slightly better chance of getting pregnant after excess tissue is removed.

However, if there is no pain, the risks of surgery usually outweigh any benefit in terms of improved fertility. You need to weigh the pros and cons with a surgeon to make a fully informed choice.

Summary

Up to 50% of women with endometriosis have difficulty getting pregnant. There are many causes, including poor egg quality and adhesions or ovarian cysts that block fertilization or implantation. Women with stage 1 or stage 2 tend to have a better chance of getting pregnant than women with stage 3 or 4, but this is not always the case.

Based on many factors, including your age and the stage of endometriosis, your healthcare provider may advise you to try getting pregnant naturally for six months. If that does not work, other options are available, including intrauterine insemination (IUI) or in vitro fertilization (IVF). Surgery may improve the odds of pregnancy but the benefit is likely small compared to the risks.

Frequently Asked Questions

  • Can endometriosis return after surgery to remove endometrial lesions?

    Yes, endometriosis has a recurrence rate of about 20% to 40% within five years after surgery.

  • How common is endometriosis?

    Endometriosis affects around 2% to 10% of women between the ages of 25 and 40.

  • What are the stages of endometriosis?

    The stages of endometriosis are 1 through 4, which represent minimal, mild, moderate, and severe disease. These stages are classified based on location, quantity, and depth of the endometrial tissue.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is the author of "The Doula Advantage" and "Birth Plans for Dummies," and a member of the Association for Health Care Journalists. She has contributed to Reuters Health, USA Today, and more.