You can get pregnant with endometriosis, even if it's advanced, though it may not be easy. Research shows one-third to one-half of women with endometriosis have trouble conceiving naturally.
In endometriosis, tissue similar to the endometrial lining of the uterus (womb) grows around your reproductive organs. It can also cause scar tissue and adhesions, which is when tissue sticks together. This can make it harder to get pregnant, but not impossible.
If you have endometriosis and want to get pregnant, medical treatments can help you conceive. However, endometriosis is associated with higher risks of pre-term birth, low birth weight, miscarriage, and other concerns during pregnancy.
This article discusses endometriosis and pregnancy. It explains how endometriosis can impact fertility and the treatments that may help you get pregnant. It also discusses the risks of pregnancy complications in people with endometriosis.
How Endometriosis Affects Your Ability to Get Pregnant
Endometriosis affects 10% to 15% of females of child-bearing age. A 2022 study reported that 35% to 50% of women with endometriosis are infertile, meaning they are unable to conceive naturally after a year of trying.
Endometriosis can cause difficulty conceiving for multiple reasons, including:
Ovarian cysts: Endometriosis can spread to the ovaries and produce cysts. Unlike other ovarian cysts, these cysts—called endometriomas—can cause infertility by either blocking the release of an egg from its follicle or the passage of the egg into the fallopian tube.
Adhesions: The overgrowth of tissues can cause adhesions. Adhesions are scars that form between tissues inside the body and cause them to stick together. This can prevent an egg from making its way from the fallopian tube to the uterus, or sperm from reaching the egg.
Egg quality: Studies have found that endometriosis affects the quality of eggs in the ovary.
Pain during sex: Pain during sex is one of the more common symptoms of endometriosis and one that can reduce the odds of getting pregnant by reducing your ability to have intercourse.
Treatment: Symptoms of endometriosis are often controlled with hormonal birth control. In this case, the prevention of pregnancy is an unwanted effect.
How Endometriosis Causes Infertility
How Endometriosis Affects Pregnancy
Most pregnancies with endometriosis are successful and uncomplicated. However, endometriosis does carry some pregnancy risks. These include:
Miscarriage: Pregnancies with endometriosis are 60% more likely to miscarry than those without it. No one knows for sure why this happens, since women with milder disease appear to be at greater risk than those with severe disease.
Ectopic pregnancy: Endometriosis more than doubles the risk of ectopic pregnancy. Also known as a tubal pregnancy, this is a nonviable pregnancy that occurs when a fertilized egg implants outside the uterus, commonly the fallopian tube.
Gestational diabetes: Rates of gestational diabetes are 40% higher in pregnancies with endometriosis. High blood sugar levels from diabetes can result in a bigger baby and a more difficult delivery. Gestational diabetes can often be managed with diet and exercise, though insulin is sometimes needed to lower high blood sugar.
Hypertension: Endometriosis increases the risk of gestational blood pressure disorders by 45%. This includes hypertension and preeclampsia, a serious and sometimes fatal condition that causes elevated blood pressure, kidney problems, and seizures, and requires close monitoring.
Preterm birth: Rates of preterm labor and birth (prior to 37 weeks gestation) are 48% higher in pregnancies with endometriosis.
Low birth weight: Endometriosis increases the likelihood of a baby weighing less than 5.5 pounds at birth by 55%. Low birth weight is linked to breathing problems, low blood sugar, jaundice, and difficulty regulating body temperature in infants.
Does Pregnancy Cure Endometriosis?
A 2018 review of published literature found insufficient evidence to support the theory that pregnancy can improve endometriosis symptoms, reduce the size or number of related lesions, or cure the condition outright.
How to Follow an Endometriosis Diet
Trying to Conceive With Endometriosis
If you've been diagnosed with endometriosis, it's worth trying to conceive on your own before seeking treatment.
Most experts advise that you try to conceive naturally for six months (rather than the 12 months recommended for other women). If you don't get pregnant within that timeframe, then you should speak with a fertility specialist.
With that said, some people go straight to a specialist, especially if they are older. After 35, natural fertility declines in every woman. For some, those six months may be better spent under a specialist's care.
How Does Artificial Insemination Work?
Fertility Treatment Options
Fertility drugs alone are not typically used in women with endometriosis who want to get pregnant. They don’t improve pregnancy rates much compared to those who try to conceive naturally.
The most effective treatment for endometriosis-related infertility depends on your age, the stage of the disease, your infertility risk factors, treatment costs, and personal choice.
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are options you can consider, even with endometriosis.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) along with fertility drugs is the typical starting point for women with stage 1 or 2 endometriosis. IUI is a procedure where sperm is introduced into the womb during ovulation.
Clomid (clomiphene) and gonadotropin are the fertility drugs commonly used for IUI. Clomid is usually used first, as it is less likely to cause multiple births or a potentially serious condition called ovarian hyperstimulation syndrome (OHSS) that causes ovaries to swell.
Studies have shown that, in women with endometriosis, combining IUI with Clomid or gonadotropin triples the odds of getting pregnant compared to trying naturally.
Managing Endometriosis Symptoms Through Self-Care
In Vitro Fertilization (IVF)
If IUI does not work, the next step is in vitro fertilization (IVF). IVF involves removing eggs and fertilizing them outside of the body, then transferring them into the womb. It provides the best chance of getting pregnant, but is also costly and invasive.
IVF is sometimes used as the first-line treatment option if a woman is over 35, has stage 3 or 4 disease, or has additional risk factors for infertility (such as low egg quality or quantity).
Studies have shown that the success rate of IVF in women with endometriosis is around 22%, more or less in line with women with other causes of infertility.
IVF is not an option for all individuals. Some prefer less intensive treatments, while others simply cannot afford the cost of IVF. For them, multiple rounds of IUI, surrogacy, or adoption may be suggested.
How In Vitro Fertilization (IVF) Works
Surgery and Fertility Rates
The number one reason for endometriosis surgery is to reduce pain symptoms. Beyond pain reduction, surgery may help increase the odds of pregnancy in some—but not all—women.
For those with severe endometriosis, surgery does not appear to improve success rates for IUI or IVF. In fact, repeated surgeries can cause adhesions that make pregnancy more difficult.
On the other hand, some studies suggest that women with stage 2 or 3 endometriosis may have a slightly better chance of getting pregnant after excess tissue is removed.
However, if there is no pain, the risks of surgery usually outweigh any benefit in terms of improved fertility. You need to discuss the pros and cons with a surgeon to make a fully informed choice.
Endometriosis Doctor Discussion Guide
Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.
Pregnancy is possible with endometriosis, though it may be more difficult to conceive naturally. This can be due to issues such as poor egg quality, adhesions, or ovarian cysts that block fertilization or implantation.
Your healthcare provider may advise you to try getting pregnant naturally for six months. If that does not work, intrauterine insemination (IUI) or in vitro fertilization (IVF) may be recommended. Surgery may improve the odds of pregnancy, but the benefit is likely small compared to the risks.
The majority of pregnancies in people with endometriosis are successful, uncomplicated, and result in a health baby. However, the condition does increase the risk of pre-term labor, miscarriage, and other pregnancy concerns.
Coping with Endometriosis
Frequently Asked Questions
Can endometriosis return after surgery to remove endometrial lesions?
Yes, endometriosis has a recurrence rate of about 20% to 40% within five years after surgery.
How common is endometriosis?
Endometriosis affects around 2% to 10% of women between the ages of 25 and 40.
What are the stages of endometriosis?
The stages of endometriosis are 1 through 4, which represent minimal, mild, moderate, and severe disease. These stages are classified based on location, quantity, and depth of the endometrial tissue.