Written by: Heidi Wright, BSN, RN, PCCN
If you have endometriosis and are considering trying to conceive, you are not alone. Endometriosis affects millions of individuals with reproductive systems worldwide. It occurs when tissue that is similar to the lining of the uterus, known as the endometrium, grows outside the uterus, leading to various symptoms and potential fertility concerns. If you have been diagnosed with endometriosis or suspect you may have it, understanding what endometriosis is, its impact on fertility, and exploring available treatment options is understandably important for your journey toward parenthood. We are here for you as you seek out information on fertility and endometriosis and advocate for yourself. Let’s delve into the relationship between endometriosis and fertility, and address some of the common questions people ask when considering trying to conceive with endometriosis. We want you to feel empowered and knowledgeable as you approach your pre-pregnancy planning and medical appointments.
Understanding Endometriosis and Its Impact on Fertility
Endometriosis is a complex condition that can impact fertility in several ways. It can cause infertility in some endometriosis cases and not affect fertility at all in other cases. To better understand the potential challenges of living with this chronic condition, we’ll be answering some common questions about what endometriosis is, the symptoms of endometriosis, how it affects fertility, possible treatment options, and more. Let’s get into it.
What is endometriosis?
Endometriosis is a medical condition that affects people with uteruses, and it can start anywhere from puberty to later in life. It happens when tissue similar to the lining of the uterus (the womb) grows outside of it. This tissue, called endometrial tissue, can grow on the ovaries, fallopian tubes, and other organs in the pelvis. It has even been found in the chest cavity! When a person has their period, this extra tissue inflames and can cause pain, swelling, and sometimes scar tissue. Endometriosis can make it harder to get pregnant because it can affect the ovaries and the eggs they produce, as well as cause structural changes making it challenging to conceive. Understanding endometriosis is important for those who may have it, as it helps them take the necessary steps to advocate for themselves, and manage the condition and its impact on their fertility.
What are the symptoms of endometriosis?
The signs and symptoms of endometriosis look different from person to person and can also change over time. Some common signs and symptoms of endometriosis include
- Painful menstrual periods. Individuals with endometriosis may experience intense cramping and pelvic pain during their periods.
- Chronic pelvic pain.Persistent pain in the pelvic region, outside of menstrual periods, is a common symptom of endometriosis.
- Painful intercourse. Endometriosis can make sexual intercourse uncomfortable or painful. The pain can also occur after having sex.
- Heavy menstrual bleeding. Individuals with endometriosis may experience abnormally heavy or prolonged menstrual bleeding. This is a condition called dysmenorrhea.
- Fatigue. Feelings of exhaustion or low energy levels are often reported by individuals with endometriosis. This fatigue is often persistent and without other known causes.
- Digestive issues. Some individuals may experience digestive problems such as bloating, constipation, or diarrhea during their menstrual cycles. These symptoms may persist all throughout the monthly cycle, and bowel movements may be accompanied by pain.
- Urinary issues.It may be difficult or painful to urinate, or the bladder may spasm, especially during menstruation.
- Infertility. Difficulty getting pregnant or infertility can be associated with endometriosis. Often endometriosis is diagnosed when people start looking for a reason they can’t get pregnant and seek infertility care from a healthcare provider.
It is important to note that the severity of symptoms can vary among individuals, and not everyone will experience all of these symptoms. If you suspect you may have endometriosis or are experiencing any of these symptoms, get with your primary healthcare provider to review your symptoms and for proper diagnosis and treatment. There are other disease processes that mimic these symptoms, so it’s important to get checked out.
How does endometriosis affect fertility?
EEndometriosis can hinder fertility in different ways in different bodies. It’s estimated that impaired fertility occurs in 33%-50% of people with endometriosis. Here are a few of the most common symptoms of endometriosis that affect fertility in negative ways
- Distorted pelvic anatomy.Endometriosis can cause adhesions, scar tissue, and ovarian cysts, which may affect the normal functioning of the reproductive organs, including the fallopian tubes, ovaries, and uterus. These issues can damage the egg, or not allow it to get to where it needs to go to be fertilized.
- Hormonal imbalances. The abnormal growth of endometrial tissue can disrupt hormonal balance, suppress ovarian function, and affect overall fertility.
- Inflammation and immune response.Endometriosis triggers an inflammatory response in the body, potentially impacting fertility by interfering with the fertilization process or embryo implantation during a complex inflammatory response process.
What are the chances of getting pregnant with endometriosis?
Take heart, friends. While endometriosis can cause some challenges to trying to conceive, it does not mean that pregnancy is impossible or even unlikely! According to the American Society for Reproductive Medicine, “Up to 30% to 50% of women with endometriosis may experience infertility.“ Infertility is typically defined as the inability to conceive after one year of unprotected sex. When you seek care for endometriosis, your healthcare provider will review the likelihood of getting pregnant depending on various factors
- Disease severity and location. The impact of endometriosis on fertility can vary based on the extent and location of the endometrial implants.
- Age. Age plays a crucial role in fertility, and the presence of endometriosis may compound the natural decline in fertility as individuals with reproductive systems age because endometriosis can cause damage to these systems over time.
- Coexisting factors. Other factors, such as the presence of male factor infertility or underlying conditions like polycystic ovary syndrome (PCOS), can influence fertility outcomes.
How is endometriosis diagnosed?
If you suspect you have endometriosis or experience symptoms such as pelvic pain, painful periods, or infertility, it is essential to seek advice from your healthcare provider. The diagnosis process may involve
- Detailed medical history and symptom assessment. Your healthcare provider will ask you about any previous health problems and surgeries you’ve had in the past, and your current diagnoses and medications. Come prepared with a written history, medication list, allergy list, and a list of the symptoms you are experiencing.
- Pelvic examination. Be prepared for the standard OBGYN internal pelvic exam, as well as an abdominal external exam.
- Imaging tests like ultrasound or magnetic resonance imaging (MRI) may be ordered.
- Laparoscopy, a minimally invasive surgical procedure, is often used for definitive diagnosis and treatment confirmation.
What are the treatment options for endometriosis?
When it comes to treatment, the ultimate goal of medical management of endometriosis is to alleviate the symptoms and reduce disease progression. Endometriosis is often diagnosed as a chronic condition, meaning it is a lifelong condition that is managed over a long period of time. The type of treatment a person needs depends on the progression of their disease and the severity of symptoms.
Common treatment options for endometriosis include
- Hormonal therapies. Such as combined oral contraceptives, progestins, or gonadotropin-releasing hormone (GnRH) agonists/antagonists, which can help control symptoms and reduce the growth of endometrial implants.
- Pain management. Over-the-counter pain relievers or prescribed medications can provide relief from pelvic pain associated with endometriosis.
- Surgical therapies. Laparoscopic excision is one method of surgery that involves the removal of endometrial implants and adhesions while preserving healthy tissue. Laparoscopic ablation involves ablating endometrial tissue using a surgical laser or other techniques.
Tips for Getting Pregnant With Endometriosis
On to the good stuff… if you’ve been diagnosed with endometriosis and started treatment, there are some things you can discuss with your healthcare team when thinking about trying to conceive. Start by asking for an overall picture of the severity of your endometriosis, and if there are any interventions that can be done right away to help your chances of conception. Interventions discussed with you could include conservative laparoscopic surgery or medications. Ask if you need to see a fertility specialist, and if there are any future considerations regarding your fertility that you need to be prepared for. It could also be that you don’t need surgery or prescriptions, but you do need supportive therapies and pain reduction.
Here are some things you can start now to support your reproductive system. Certain lifestyle changes may positively impact fertility outcomes for individuals with endometriosis
- Maintaining a healthy weight. Being underweight or overweight can affect fertility, so strive for a balanced weight through a nutritious diet and regular exercise.
- Stress management. Stress can affect hormone balance and overall well-being, so incorporating stress reduction techniques like yoga, meditation, or counseling can be beneficial.
- Avoid smoking and excessive alcohol consumption.These habits can adversely affect fertility and should be minimized or eliminated.
Painful Sex and Timing Intercourse With Endometriosis
One of the most common symptoms of endometriosis is pain during and after sex, and painful sex is a major obstacle to getting pregnant. When trying to conceive, optimizing the timing of intercourse during your ovulation window can improve the chances of conception; however, this can be a really stressful time for couples. Insemination at home is an option for those with open fallopian tubes trying to conceive. It can be a more relaxed and intimate experience compared to in-office methods, used in the comfort of one's own home. This can alleviate the stress and pressure associated with timed intercourse, allowing couples to focus on the emotional connection and enjoyment of the process. The Mosie Baby Kit is designed to relieve some of the stress of timed intercourse with a comfortably designed at-home alternative. At-home intravaginal insemination is one way to try to conceive at home without intercourse, to potentially avoid that vaginal pain or discomfort. Mosie Baby provides a unique and user-friendly approach to at-home insemination, specifically tailored for those trying to conceive. At-home insemination can remove the barrier of painful sex when trying to conceive, and relieve some of the pressure of the timing of sex.
Insemination at home is used by individuals trying to overcome certain challenges or factors that may hinder trying to conceive. For example, issues such as low sperm count, low sperm motility, or other difficulties with sexual intercourse can be addressed by trying this method. Folks with endometriosis, cervical mucus issues, or other fertility concerns can benefit from artificial insemination as it provides a direct pathway for sperm to reach at or near the cervical opening inside the vagina and potentially achieve pregnancy. At-home insemination is not a fertility treatment or a substitute for professional medical advice. If you are facing specific fertility challenges or have concerns about your fertility (such as you’ve been trying to get pregnant for six months to a year and have not been able to conceive), it is recommended to consult with a healthcare professional for a comprehensive evaluation.
Treating Infertility and Assisted Reproductive Technology
Several fertility treatments are available to help people with infertility conceive. The right path for you will vary based on your symptoms and your doctor's recommendations.
Assisted reproductive technologies, such as in vitro fertilization (IVF), may be considered in cases where conception is challenging due to the location of endometrial implants. If implants and anatomical difficulties are not an issue, Intrauterine insemination (IUI) may be presented as an option for you. IUI is a type of artificial insemination that is done under the supervision of a healthcare provider in the clinic. With IUI, sperm are washed, concentrated, and placed directly into the uterus. The timing of IUI has to be matched up with ovulation. Consulting with a fertility specialist can provide personalized guidance and treatment options tailored to your specific needs.
Emotional Health and Seeking Support For Endometriosis
Endometriosis and the challenges associated with fertility can take a toll on emotional well-being. Having the right resources, knowledge and support is key. Managing endometriosis can affect your daily quality of life. The fatigue, gnawing pain, and other symptoms can drain your emotional resources and coping mechanisms. Acknowledge and address the stress, the pain, and the emotions associated with living with endo. We often focus on the physical health of our bodies, but fail to address the many emotional and mental health complications living with a chronic illness can bring.
Because of the effect endometriosis has on emotional wellness and intimacy, we want to remind you that coping strategies and support are available to you. Some good first steps are
- Seek out emotional support.Share your feelings with your partner, family, or friends who are a safe space and can provide comfort. Share about your condition and give them insight into just how much endometriosis has affected your day-to-day quality of life.
- Join support groups. Your partner may be supportive, but not necessarily understand what you’re going through or how to best help. Connecting with others who are going through similar experiences can provide a sense of community and valuable insights.
Professional counseling.Seek counseling or therapy to navigate the emotional challenges and intimacy challenges associated with endometriosis and infertility.
An Endometriosis Diagnosis Does Not Mean You Will Be Infertile
For people with endometriosis, it usually is possible to get pregnant, but your path may look different. Your role in taking control of your fertility with endometriosis is finding a healthcare team that will support you, listen to you, diagnose you, and treat your condition. Endometriosis is frequently undiagnosed for a longer period than other conditions, as the pain that accompanies the condition is often misinterpreted as menstrual cramps, or there may be an absence of noticeable symptoms. It takes an average of 10 years for women in the United States to obtain an accurate diagnosis for endometriosis. By understanding the impact of endometriosis on fertility, exploring various treatment options, and taking proactive steps to enhance fertility, individuals with endometriosis can increase their chances of conceiving. It’s important to consult with a healthcare provider specializing in reproductive health to develop a personalized plan tailored to your specific situation.
With the right support and guidance, you can overcome challenges and work toward your dream of becoming a parent. Seeking out support is a brave thing to do, especially if you’ve had a long journey to your endometriosis diagnosis. We’re here for you, we’re hoping for you, and we’re proud of you. Keep going!
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Heidi Wright, BSN, RN, PCCN is a Registered Nurse passionate about public health and expanding healthcare resources and prenatal care to diverse, rural, and underserved Hispanic, African American, American Indian, and Alaska Native communities. With 20 years of experience in healthcare, Heidi specializes in supporting patients with chronic illness and reproductive system disorders.