Having Endometriosis does not mean you can’t get pregnant.
With the right medical support and timely intervention, many women go on to conceive and carry healthy pregnancies. If you are concerned about fertility, seek guidance from your healthcare provider to explore all available options.
Endometriosis is a chronic inflammatory condition where tissue resembling the endometrium (the lining of the womb) grows outside the uterus. This misplaced tissue responds to hormonal changes during the menstrual cycle, just as the uterine lining does, thickening, breaking down, and bleeding. However, unlike menstrual blood, this tissue has no way to leave the body, leading to inflammation, scarring, and the formation of adhesions (bands of scar tissue) [1].
Endometriosis affects roughly 10% of women of reproductive age worldwide [2]. In the UK alone, around 1.5 million women are currently living with the condition [3]. It is a major cause of chronic pelvic pain and a leading contributor to infertility.
How Endometriosis Affects Fertility
Fertility problems occur in approximately 30–50% of women with endometriosis [4]. The condition can affect fertility in several ways:
- Anatomical disruption: Endometriosis can distort pelvic anatomy. Adhesions and cysts may block or impair the fallopian tubes, preventing the egg and sperm from meeting.
- Ovarian function: Ovarian endometriomas (also called “chocolate cysts”) can interfere with ovulation and egg quality.
- Inflammation: The immune response and inflammation associated with endometriosis may negatively affect sperm function, egg quality, and embryo implantation.
Even mild cases, where the anatomy remains unaffected, can still disrupt fertility at the cellular or hormonal level.
Key Anatomical Sites
Endometriosis is most commonly found in:
- Ovaries – where it may form cysts (endometriomas).
- Fallopian tubes – potentially leading to blockages.
- Peritoneum – the lining of the pelvic cavity.
- Uterosacral ligaments – causing severe pain during menstruation or intercourse.
Less commonly, it can be found on the bladder, bowel, and even beyond the pelvis in rare cases.
Symptoms and Medical Presentations
Many women with endometriosis experience:
- Pelvic pain, especially during menstruation (dysmenorrhoea).
- Pain during or after intercourse (dyspareunia).
- Heavy menstrual bleeding (menorrhagia).
- Fatigue and digestive issues (bloating, diarrhoea, or constipation).
- Difficulty conceiving.
It is important to note that some women with severe endometriosis may have minimal or no symptoms, while others with mild disease can experience significant discomfort.
Can You Still Get Pregnant?
Yes, many women with endometriosis can and do become pregnant, either naturally or with medical support.
- Women with mild to moderate endometriosis often conceive without assistance, especially after treatment.
- Those with severe endometriosis may need help from fertility treatments such as in vitro fertilisation (IVF) or intrauterine insemination (IUI).
Surgical treatment to remove endometrial implants and adhesions can improve the chances of natural conception, particularly when the tubes are affected.
A study by Marcoux et al. (1997) showed that surgical treatment of mild endometriosis increased spontaneous pregnancy rates [5].
Assisted Reproductive Technology (ART)
For women who do not conceive naturally:
- IVF has proven successful in many cases. According to NICE guidelines, IVF offers comparable success rates for women with endometriosis and those with unexplained infertility [6].
- For women with severe ovarian damage, egg freezing or donor eggs may be recommended.
The success of ART may depend on age, disease severity, and ovarian reserve (the number and quality of eggs remaining).
Potential Complications During Pregnancy
Most women with endometriosis have healthy pregnancies, but some research suggests a slightly higher risk of:
- Preterm birth.
- Placenta previa (placenta covering the cervix).
- Preeclampsia (high blood pressure during pregnancy).
- Caesarean section delivery.
Monitoring by a specialist team can help manage these risks effectively.
Common Misconceptions
Misconception 1: “You can’t get pregnant if you have endometriosis.”
Fact: Many women with endometriosis conceive naturally. While the condition may reduce fertility, it does not guarantee infertility.
Misconception 2: “Pregnancy cures endometriosis.”
Fact: Symptoms may reduce during pregnancy due to hormonal changes, but they typically return after birth. Pregnancy is not a cure.
Emotional and Psychological Aspects
Infertility and chronic pain can lead to emotional distress, anxiety, and depression. Seeking support through counselling, support groups, or medical professionals is encouraged.
When to Seek Help
If you have endometriosis and are struggling to conceive:
- Speak to a GP or gynaecologist after 6 to 12 months of trying, depending on your age and symptoms.
- Request a referral to a fertility specialist if appropriate.
- Consider discussing laparoscopy (a keyhole surgery used to diagnose and sometimes treat endometriosis).
Early intervention improves outcomes and helps avoid delays in treatment.
References
[1] Leyendecker, G., Kunz, G., & Wildt, L. Endometriosis: a dysfunction and disease of the archimetra. Google Books
[2] Giudice, L. C. Clinical practice. Endometriosis. New England Journal of Medicine. NEJM
[3] Endometriosis UK. Facts and Figures. Endometriosis UK
[4] Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility Journal. ASRM
[5] Marcoux, S., Maheux, R., & Bérubé, S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. NEJM. NEJM
[6] National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. NICE
