Being diagnosed with endometriosis can leave you with many questions about how the condition will affect you in the future. Whether or not you are currently trying for a baby, or just considering how endometriosis could affect your fertility, one of the questions that may come to mind is: “Will I be able to get pregnant if I have endometriosis?”
Syrona Health is here to clear up any confusion. The first thing to mention is that endometriosis doesn’t directly cause infertility. There are some associated symptoms of endometriosis which can cause fertility problems, but the reassuring fact is that even if you have severe endometriosis it is still possible to conceive naturally.
There are several factors to consider when it comes to fertility and these affect the ability to get pregnant from person to person. The primary influence on fertility is always age; women are born with their lifetime supply of eggs which mature until they are fertilized. After the age of 38, egg sacs disappear from the ovaries at a much faster rate and this causes fertility to decline. The older a woman gets there is also an increased risk of miscarriage and chromosome abnormalities affecting the baby.
The reasons why endometriosis may affect fertility are not fully understood, although some studies have been done, there is not yet a concrete cause and effect. What we do know is that in moderate to severe cases of endometriosis, known as stage 3 and 4, fertility chances can decrease. The stages are based upon how much the tissue has grown and where it is, rather than the pain or symptoms experienced. Scar tissue, cysts and adhesions that grow outside of the uterus can trap the egg and stop it from moving down the fallopian tube, making it more difficult to get pregnant.
Studies have shown that if 100 women with moderate endometriosis start trying to become pregnant by the end of one-year half of them will be. In the case that they have severe endometriosis, at the end of one-year 25 of the 100 women will be pregnant.
For women who have minimal to mild cases, known as stage 1 and 2, of endometriosis chances of fertility are usually almost normal; around 70% of women with minimal to mild endometriosis will get pregnant without any treatment. However, some women can still be infertile for no apparent reason. There are several theories as to why this could be the case, which include toxins in peritoneal fluid (a fluid that occurs naturally within the body cavity), the egg sac failing to release its egg, and the egg struggling to transport down the fallopian tube.
There are several different treatment options for women struggling to get pregnant which may help to better fertility chances. The best course of treatment depends a lot on the individual’s circumstances, such as their age, for how long they’ve been trying to conceive, and what stage of endometriosis they have. If you are trying to get pregnant it really comes down to what works for you and your body.
Research has shown that surgical treatment for endometriosis can improve fertility and pain. Surgery is used to remove the scar tissue and cysts and release adhesions, which should make it easier for the egg to move down the fallopian tube and increase chances of getting pregnant. It is suggested that you try to conceive naturally for a year after surgery like this before looking for fertility treatment.
Slowing the progress of endometriosis might improve your chances of fertility as you get older and consider having a baby. This process is a long-term effort to try and stop endometriosis from progressing to a worse stage as rapidly and isn’t suitable if you are immediately trying for a baby. If this doesn’t apply to you just now, then the combined oral contraceptive pill can be effective at slowing down the progression of endometriosis.
There is a whole wealth of information out there on potential treatment methods if you are trying to get pregnant, and it is easy to get lost in all of the statistics and medical jargon. Let’s break down the list of options in a way that is easier to understand:
Ovulation induction (OI) is appropriate for young women with minimal to mild endometriosis and who have healthy fallopian tubes. OI is used to try and regulate irregular periods by stimulating the ovaries to release an egg each month.
Intrauterine insemination (IUI) is a treatment option for young women with minimal to mild endometriosis, with health fallopian tubes, and who ovulate regularly. This treatment is for the partner or sperm donor, so they must have a good number of healthy sperm for this to be suitable. IUI ensures that only the healthiest sperm are used and inserted into the womb through the cervix at the time of ovulation so that they have a greater chance of successfully reaching the egg.
Ovarian stimulation and IUI is typically for women who have minimal or mild endometriosis and have been unable to conceive naturally, even with IUI. Ovarian stimulation enhances a woman’s fertility so that she will produce several eggs in a month, normally three or four. It is considered to be more effective than no treatment or just the use of IUI when trying for a baby.
GIFT is an option for women whose endometriosis is minimal to moderate; who have healthy fallopian tubes; who are older; who have failed to conceive by IUI; and who have tried to conceive for a long time. The process involves collecting eggs from the woman’s ovaries, typically by laparoscopy, and mixing the healthiest eggs with sperm before placing them inside the fallopian tube.
IVF treatment can be used for women with moderate to severe endometriosis, as well as women with minimal to mild endometriosis whose partner has sperm issues. It is also appropriate for women with damaged or block fallopian tubes and women who have been unable to conceive with IUI. During IVF treatment, en egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg is returned to the womb to grow and develop. It can also be carried out using eggs and sperm from donors.
ICSI is an option for anyone who qualifies for IVF, particularly if there are problems with the sperm, such as a low sperm count. Another reason for using ICSI is to improve fertilisation if there are very few eggs collected from the woman. In ICSI a single sperm is injected into the egg, optimizing the chances of fertilization.
Egg or sperm donation is usually recommended to women who are unlikely to be able conceive using their own eggs or partners sperm. In the case of an egg donation, the eggs are fertilised by the sperm to produce embryos. The embryos are then transferred to the uterus to grow and develop. Sperm donation involves inserting the sperm into the cervix at the time of the women’s ovulation.
Surrogacy is suitable where pregnancy or birth is impossible or dangerous for the woman. Surrogacy means that another woman carries the baby and gives birth for you. The baby can be conceived by IUI using the surrogate’s eggs and your partners sperm. An embryo transfer can also be done with the embryos created from your eggs or eggs donated from another woman and your partner’s sperm.
There are a whole range of complementary treatments available for endometriosis, however, many lack research evidence to prove that they have any effect at all. Complementary treatments some women may find helpful include acupuncture, homeopathy, and herbal medicine. Counselling and self-help groups can also be a major part of emotional treatment for women with endometriosis.
For women with endometriosis, pregnancy and fertility may feel like a daunting process. It is important to remember that if you are currently trying to get pregnant, or are just coming to terms with how your diagnosis could affect your fertility in the future, you are not on your own. It is usually still possible to conceive naturally with endometriosis and there are fertility options available to give you the best chance. There is also emotional support, such as from the counsellors at Syrona Health, to help you every step of the way.