How Endometriosis Can Affect Pregnancy

If you have endometriosis and want to become pregnant, you’re likely concerned about the effects the condition may have on your fertility. Endometriosis is a complicated issue for many women, and can impact the body in various ways depending on its severity. 

Endometriosis causes tissue, similar to the lining of your uterus, to grow on other internal structures of the body outside of the uterus, like the organs, pelvis, or abdomen. More than 11% of people who menstruate experience endometriosis, but other than genetic propensity, physicians don’t know it’s cause. Though not all people with endometriosis will experience symptoms, many with the condition know it can be painful. 

Are endometriosis and endometritis the same thing?  

Though etymologically similar, endometriosis and endometritis are different conditions. Both affect your uterine lining, but the cause of endometritis is clear. It’s a uterine infection caused by procedures that may impact the pelvis such as a hysterectomy, placement of an intrauterine device (IUD), or a ruptured amniotic sac during childbirth. About 1-5% of all vaginal deliveries come with the risk of contracting endometritis. The risk increases with cesarean section because the bacteria that generate the infection are more likely to impact a damaged uterus. More recently, scientists have begun investigating the impact of chronic endometritis on embryo implantation. A 2016 study has shown that as much as 11.9% of women who experience repeated implantation failure have chronic endometritis.  

Does endometriosis affect my chances of getting pregnant? 

Endometriosis can occur in people ages 15-40, whether or not they choose to become pregnant. People with severe or late-stage endometriosis have a higher risk of infertility than people with mild or early-stage endometriosis. Physicians aren’t sure why the condition can impact pregnancy, but these are some common theories: 

Diminished ovarian reserves 

Women with endometriosis may experience diminished ovarian reserves (DOR), which means their ovaries age much faster than usual. DOR can cause a decline in ovary function, which may interfere with pregnancy, and the success of assisted reproductive technology like in vitro fertilization (IVF). 

Blocked fallopian tubes 

Untreated infection and endometriosis can cause scarring that blocks the fallopian tubes, which can in turn cause infertility. Most physicians recommend surgery to unblock your fallopian tube before suggesting infertility treatments like IVF. However, surgery isn’t required. The fertilized embryo can implant without traveling through your fallopian tubes in IVF. 

Displaced endometrial receptivity 

Endometriosis may displace endometrial receptivity because of inflammation and immune suppression. This means the window of implantation (WOI), the ideal moment for embryo transfer into the uterus, may be harder to capture. Procedures like endometrial receptivity tests (ERT) can help determine your WOI, and increase your chances of becoming pregnant. 

Increased rates of implantation failure 

Some evidence shows that endometriosis may impact the successful implantation of the embryo. Patients with endometriosis may see a higher rate of implantation failure, but infertility treatments like IVF can improve the chances of successful implantation. 

How is endometriosis treated? 

Many people diagnosed with endometriosis will begin a treatment plan that can include hormone-suppressing medications like birth control and other medications like pain relievers. Depending on the severity of the condition, physicians may also recommend a surgical procedure like a laparoscopy to remove cysts, scar tissue, or other growths. 

Endometriosis may or may not impact a person’s ability to get pregnant, but infertility treatment options exist to help increase the chances of successful conception. Some treatment options include intrauterine insemination (IUI) and in vitro fertilization. IVF may be best for those with later stages of the condition.  

Should endometriosis treatment come before IVF? 

The advice on choosing surgery before in vitro fertilization varies based on your age, and the severity and type of endometriosis symptoms. Some physicians recommend avoiding surgery if you plan to become pregnant because it holds the risk of reducing your ovarian reserves. Other physicians may suggest you pursue surgery anyway because the cysts may impact your IVF success rate. 

It may be beneficial to first seek advice from a multi-disciplinary team. If you wish to become pregnant, speak to a fertility specialist before pursuing treatments like surgery for your endometriosis. A fertility specialist can recommend a gynecologist and an IVF treatment expert to work with you and help you make informed decisions. 

Endometrial receptivity testing 

If you decide to pursue IVF treatment, you may want to consider endometrial receptivity tests (ERTs) to help determine your unique window of implantation (WOI). Women with endometriosis may have a difficult time getting pregnant for a variety of reasons. An ERT test like ORA™ improves the chances of a successful pregnancy for those with a limited number of viable embryos or low implantation success rate by ensuring your embryo transfer occurs at the best time for your body.  

We recommend choosing ORA™ because it is designed to offer an accurate, non-invasive solution, reducing the likelihood of additional treatment cycles. Our tests can provide you with actionable results in over 99% of first biopsies, so you can be confident that you’re getting the information you need with a much lower chance of needing multiple biopsy procedures.