How endometriosis can impact fertility — and what to do about it

How endometriosis can impact fertility — and what to do about it
About 8.5 to 10 million women in the US and 200 million worldwide are affected by endometriosis. Although this painful disorder reduces your chances of getting pregnant, it does not mean you can’t conceive. In this guide, we go over the basics of endometriosis and how it can impact fertility.
Written by Orchid Team 
Medically reviewed by Cristina Vidal, RN
  • Cristina Vidal, RN, is the IVF-Donor-Surrogate nurse coordinator at Stanford Reproductive Endocrinology and Infertility with over 20 years of experience in the fertility and reproductive clinic.

What is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of your uterus in other areas or organs of the body. The cause of endometriosis remains unclear, it’s known that the uterine lining typically sheds through the cervix into the vagina during a menstrual period. For people with endometriosis, sometimes this tissue goes through the fallopian tubes and enters the pelvis, which makes it difficult to clear the pelvis of these cells.

This tissue can grow and attach to other areas in your body. The most common areas include the lining of the pelvic area (peritoneum), ovaries, fallopian tubes, and tissue surrounding the outside of the uterus such as the appendix, bowel, bladder, and rectum.

Endometriosis symptoms

Although rare, some women don’t experience any symptoms of endometriosis. However, many endo sufferers will report severe monthly pelvic and abdominal pain, impacting the quality of life due to chronic pain and the emotional distress associated with it.

Some other endometriosis symptoms include:

  • Painful periods
  • Painful bowel movements 
  • Pain during or after sex
  • Chronic pain in the lower back or pelvis 
  • Bleeding or spotting  
  • Constipation
  • Nausea and vomiting 
  • Bloating 
  • Infertility

During a physical pelvic exam, there can be noticeable tissue thickening, tenderness, tilted uterus, or enlarged ovaries. Pelvic ultrasounds may show blood-filled ovarian cysts and a laparoscopy examining the pelvic organs can provide a definitive diagnosis of endometriosis by looking inside your body and taking a tissue biopsy. Other non-surgical diagnostic tests include CT scans, MRI, and a hysterosalpingography.

How Does Endometriosis Impact Fertility?

Endometriosis can cause fertility issues. Around 24-50% of women with infertility can be due to endometriosis. Here are some ways growth of uterine-like tissue outside of the uterus can impact the function of your reproductive organs:

  • Endometrial tissue growth on your ovaries and pelvic adhesions can prevent ovulation — inhibiting the release of an egg. 
  • Endometriosis tissue growth can block your fallopian tubes, which can prevent sperm to enter or cause the fallopian tube to not be able to pick up the eggs during ovulation. 
  • Scar tissue and tissue that bind your organs together can cause pelvic inflammation and make it difficult to conceive
  • Increased inflammation causes the production of cytokines — which impacts the immune system and hormone changes and makes fertilization more difficult.

What Can I Do to Improve My Chances of Getting Pregnant If I Have Endometriosis?

If you have endometriosis and wish to conceive, find a specialist to decide on the best course of treatment. Here are a few treatment options to consider:

Hormone medications — Your doctor may prescribe a gonadotropin-releasing hormone (GnRH). These medications will cause estrogen levels to drop which can reduce endometrial growth. They are usually taken for about 6 months, and low dose estrogen/progestin hormone therapy may be added when prolonged treatment is needed or if symptoms persist. Calcium supplements and exercise is recommended to reduce the bone density loss that may occur while on this therapy. Hormonal contraceptives may also help reduce menstrual cramping and pain. Consult your physician for these options and review potential side effects.

Surgery — This is one of the first lines of treatment. During laparoscopy (a surgical outpatient procedure) the physician can confirm an endometriosis diagnosis and remove nodules, ovarian cysts and adhesions through surgery. If endometriosis is severe, sometimes the recommendation is major surgery to remove endometriosis and adhesions. It has been shown to improve pain symptoms, though sometimes recurrent symptoms may appear within 5-10 years with new endometrial growth.

Fertility treatment — Before deciding on the course of treatment such as IUI or IVF, an evaluation by a fertility specialist is needed. If the endometriosis is mild, fertility treatment can be done, but in other cases, surgery through laparoscopy may be recommended before starting any type of fertility treatment.

Lifestyle changes — Many endo sufferers have found success with fertility through diet and lifestyle adjustments.

Here are a few tips for managing symptoms and increasing fertility:

  • Exercise regularly to prevent the progression of endometrial growth
  • Changing sex positions can help reduce pain due to deep penetration 
  • Over the counter nonsteroidal anti-inflammatory like Ibuprofen and Naproxen can help decrease the painful menstrual cramps.
Fertility treatment and reproductive medicine have come a long way since IVF was first introduced over 40 years ago. If you are planning on starting or growing your family, check out our expert guides on all things genetics and fertility. Today, advanced genetic screening is now available to couples who want their child to have the best shot of a healthy life. Explore how Orchid helps you conceive with confidence.
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