I have endometriosis. Can I ever get pregnant?
The short answer is: absolutely.
Having endometriosis may seem painful, frightening, and hopeless, but the silver lining is the chances of a woman with endometriosis getting pregnant (with a little help in some cases) are very good.
What is endometriosis?
Endometriosis is a condition where endometrial tissue, which is normally inside the uterus, grows outside the uterus on the ovaries, pelvic cavity, and fallopian tubes.
What causes it?
There are several theories for what causes endometriosis because none of them can explain everything we see clinically. The most popular theory is retrograde menstruation. In this theory, some of the menstrual fluid exits the uterus out of the fallopian tubes into the pelvic cavity instead of all of the menstrual fluid exiting out of the vagina. The menstrual fluid that ends up in the pelvic cavity is then thought to be the seeds for the endometriosis implants. A second theory is coelomic metaplasia. For this theory, specific cells that cover much of the pelvic cavity just transform into endometrial cells for unknown reasons. It is then believed that those transformed cells act as the seeds for the endometriosis implants. A third theory is the spread of endometrial cells via the blood or lymphatic system. This theory may explain how endometrial cells can get outside the pelvic cavity into distance places such as the lungs.
How does it affect fertility?
Endometriosis is thought to cause infertility primarily through inflammation. The inflammation can directly interfere with the development and/or interaction of the sperm and egg. Endometriosis can also cause scar tissue to form in the pelvis due to the inflammation. The scar tissue, if it forms by the fallopian tubes, can cause blockage of the fallopian tubes so the sperm and egg cannot meet to fertilize. Overall, endometriosis sets up a hostile environment for the sperm and egg inside the pelvis that impedes becoming pregnant.
So how can I get pregnant, then?
Some women with endometriosis can get pregnant without any assistance, but for those that have been trying to become pregnant without any luck, there are options. Since endometriosis is thought to cause infertility by creating a hostile inflammatory environment for the sperm and egg, it makes the most sense to remove the sperm and egg from that hostile environment. In Vitro Fertilization (IVF) does exactly that by allowing the sperm and egg to interact outside the body. With IVF, the fertilization and embryo growth happens outside the body in the lab. Additionally, once the embryo has developed sufficiently, it does not need to travel down the fallopian tube, which may have been blocked by endometriosis scar tissue. Instead of traveling down the fallopian tube to get to the uterus, the embryo is transferred directly back into the uterus at the blastocyst stage.
Are chances of IVF success good for women with endometriosis?
The prognosis for patients with endometriosis entering IVF treatment is very good. It offers the highest chances of a live birth out of all treatment options available.
What can I do about the pain I have with endometriosis?
The pain caused by endometriosis is due to the inflammation it produces in the pelvis. Unfortunately, the best medical approaches to reducing endometriosis associated pain are also counterproductive for getting pregnant. The reason is, in general, medical therapies that favor getting pregnant are associated with higher levels of estrogen while medical therapies that favor pain reduction are associated with lower levels of estrogen. The good news for women with endometriosis pain who want to get pregnant is that the pain will likely decrease naturally during pregnancy because of hormonal changes. This is due primarily to the very high levels of progesterone that counteract the effects of estrogen. Women who are not trying to get pregnant that have endometriosis associated pain can use over the counter painkillers, birth control pills, and other medical therapies that can induce a low estrogen state.
So what should I do now?
Women with endometriosis looking to conceive should see a fertility doctor as soon as they have been diagnosed with infertility. If you are under 35 years old and have been trying for one year or more, or, if you are 35 years old or older and have been trying for six months, it’s time to see a fertility specialist for help.