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Fertility & pregnancy

It is important to remember that most women with endometriosis will become pregnant without any medical assistance. About one-third of women with endometriosis have trouble with fertility and struggle to get pregnant. This is likely to affect women in different ways and can create a rollercoaster of emotions. Once pregnant, many women also worry about the effect of their endometriosis on their pregnancy and delivery.

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Endometriosis & fertility

About 30% of women with endometriosis have trouble getting pregnant. It is thought that the reasons are related to:

  • scarring of the tubes and ovaries from endometriosis
  • problems with the quality of the egg
  • problems with the embryo travelling down the tube and implanting in the wall of the uterus due to damage from endometriosis
  • changes of the organs in the pelvis such as adhesions with scarred pelvic tissue and blockage of the fallopian tubes.

It is important to remember that most women with endometriosis will become pregnant without any medical assistance. For women diagnosed with severe endometriosis (stage III/IV) who do want to become pregnant, about 75% will be able to do so – two-thirds naturally and one-third with the help of IVF.

Not all women with endometriosis will be able to have a baby, just as there are women who do not have endometriosis or other health issues who are unable to have a baby.

Fertility treatments

Laparoscopic surgery (keyhole surgery using a thin telescope with a light inserted through a small cut in the belly button to look into the pelvis) is an operation that may be offered. It aims to potentially reduce pain symptoms and improve fertility by removing endometriotic patches, implants, cysts, nodules and adhesions by cutting them out (excision) or vapourising them (destroying using electrical energy).

If treatment is unsuccessful, or for women with more severe endometriosis, assisted reproduction such as in vitro fertilisation (IVF) treatments may also be considered. However, before trying this form of treatment, it is important that your endometriosis is properly assessed and treated by an experienced gynaecologist.

Tools such as the Endometriosis Fertility Index (EFI) improve the prediction of pregnancy by natural means or with the assistance of IVF, and your doctor will be able to advise which is the best pathway for you.[1, 2]

In order to attempt pregnancy, a woman needs to stop hormonal suppression of her endometriosis. Not being on hormonal suppression increases the risk of endometriosis recurrence by 35–50% over 5 years. If IVF is needed, there is some concern that the hormonal stimulation used for IVF cycles may increase the risk of endometriosis recurrence. However, there is no data showing a significant increase in recurrence rates between no hormonal suppression or IVF hormone use.

Not all recurrences are symptomatic. If there are problematic symptoms after trying for pregnancy, they can be treated then.

Please visit our webpages on fertility if you would like more information.

Anxious woman holding a pregnancy test

Feelings

The effect of having endometriosis and troubles with fertility may cause different feelings, such as:

  • worry
  • confusion
  • feelings of inadequacy
  • anger
  • stress
  • sadness
  • depression
  • grief.

It is often during investigations to see why you are not getting pregnant that the diagnosis of endometriosis is made. In 30% of women who are having difficulty becoming pregnant, endometriosis is the cause. So, any distress over trying to get pregnant may be increased by the stress and shock of the diagnosis of endometriosis.

Some women with endometriosis feel pressured to have children as soon as possible to increase their chances of becoming pregnant. You may feel overwhelmed because you don't feel ready to have children, or you want to have a child but you:

  • do not have a partner
  • have not been in the relationship for long
  • are with a partner who is not ready to have children

Other women may be ready to have children but can't get pregnant. As a result, they might have feelings of frustration, hopelessness and may be more prone to depression.

Talking to a doctor, counsellor or psychologist can help you to cope with these feelings and help you to decide what to do next.

Fertility treatments & feelings

Starting on fertility treatment can lead to a range of different feelings, from happiness and excitement to frustration, disappointment and sadness.

If you decide to try fertility treatment, it is important both you and your partner are supported through the process. Most IVF units will have counsellors who will support and counsel you through the assessment and treatment time. Getting counselling before starting treatment can help you to:

  • prepare for the emotional journey ahead
  • cope with any unsuccessful treatments or miscarriages
  • develop strategies for coping with other people's pregnancies/births
  • talk through how both you and your partner are feeling throughout the process.

Endometriosis & pregnancy

Once pregnant, many women worry about the effect of their endometriosis on their pregnancy and delivery. It is recommended that medical care should not stop once you become pregnant.

Symptoms during pregnancy

Pregnancy does not cure endometriosis, but symptoms of endometriosis can be reduced or absent because women do not have periods during pregnancy. This improvement in symptoms may be because of hormone changes in pregnancy. However, some women continue to experience pain symptoms through their pregnancy.

Complications and risks during pregnancy

Research looking at the effect of endometriosis on pregnancy provides results that are inconsistent, and more research is needed in this area. Some studies suggest that complications of endometriosis during pregnancy are rare and that there is no evidence that it has a major effect on pregnancy outcomes.[4] While other research reports an increased risk of miscarriage and ectopic pregnancy and complications such as placenta praevia, preterm birth or bleeding.[5] Most women with endometriosis will have a normal, uncomplicated pregnancy and currently extra monitoring is not recommended, but this is something to discuss with your doctor.

After delivery

Women's experiences of endometriosis after the baby is born are different. For many women, their symptoms return after they stop breast-feeding and their periods have returned. For others, their symptoms improve or resolve following pregnancy, as they may do with other medical or surgical treatments. It's important that the medical care of endometriosis continues after the birth of the baby. Discuss the management and treatment with your doctor.


This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2019.

References

Last updated: 26 November 2019 | Last reviewed: 15 May 2019

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