Can you get pregnant with endometriosis?

Getting pregnant or trying to conceive can be a difficult or upsetting time for couples. There are many factors that affect how quickly a couple gets pregnant. These factors include your age, general health condition, including reproductive health, and how often you have sex.

Naturally, there is a 1 in 20 chance of conceiving whenever a couple have unprotected sex, this chance however decreases with the females’ age. Generally, most couples (about 84 out of every 100) will get pregnant within a year if they have regular sex and do not use contraception.  Specifically, In women aged 19 to 26 years, 92% will conceive after 1 year and 98% after 2 years; while in those aged 35 to 39 years, 82% will conceive after 1 year and 90% after 2 years of regular sex. Regular sex is defined as having sex every 2 to 3 days throughout the month.

There are however, conditions that affect the fertility of the woman making it difficult to get pregnant despite favourable conditions like adequate sex and young age. One of such conditions is endometriosis.

What is endometriosis?

Endometriosis is a condition where the tissue resembling that lining of the uterus also called endothelium, is located outside of the uterus. As a result, there is often a resultant chronic inflammatory reaction that may result in the formation of scar tissue also called adhesions or fibrosis within the pelvis and other parts of the body where it is located. Endometriosis can be located in the pelvic peritoneum, ovary, recto-vaginal septum, bladder, and bowel. It affects roughly 10% of women. It is classified from stages 1 to 4 based on its severity.

Endometriosis and fertility

One of the main symptoms of endometriosis is infertility or difficulty in getting pregnant. The prevalence of endometriosis increases dramatically to as high as 25%–50% in women with infertility and 30–50% of women with endometriosis have infertility. The fecundity rate (reproductive potential) of normal women is 20%, while this is reduced to about 2% to 10% in women with endometriosis. Endometriosis reduces fertility in the following ways:

Endometriosis is associated with increased inflammatory cells in the peritoneal fluid and cysts in the ovaries or endometriomas. The consequent inflammatory effects resulting from the presence of these cysts in the ovaries have been shown to negatively affect both oocyte production and ovulation in the affected ovary.

The inflammatory environment in the fallopian tubes impairs tubal function and decreases tubal motility.  This means that the egg many not be effectively transported via the fallopian tubes even if ovulation occurs. The scars produced in severe endometriosis can also block the tubes.

Endometriosis also causes implantation failure in the uterus by altering the nature of its endothelium.

The presence of inflammatory mediators can also damage the DNA of the sperm, making it difficult to fertilize the ovary.

These effects, in addition to the pain caused during sex which makes sex uncomfortable and may reduce the frequency of sex, all contribute to the infertility seen in endometriosis.

Can you get pregnant with endometriosis?

Despite the documented fertility issues with endometriosis, women with endometriosis can get pregnant naturally. This is especially true if they have mild or moderate endometriosis and are younger than 35 years. However, even women with severe endometriosis, though not commonly can also get pregnant.

It is advised that instead of waiting for one year before being evaluated for infertility, women with endometriosis should go for evaluation 6 months after unprotected intercourse and desired fertility without getting pregnant. Earlier treatment will lead to a higher chance of pregnancy in such women.

Treatment options

There are several treatment options to increase the chances of women with endometriosis getting pregnant. Laparoscopy to remove the endometriosis tissues can be done in women less than 35 years with mild or moderate disease. Surgery can also be done to remove scar tissue in severe cases, this however can further reduce the ovarian reserve. If pregnancy does not occur within 6 months after surgical treatment of endometriosis, or if the woman is aged 35 years and older,  or in moderate and severe disease; other fertility treatments like intrauterine insemination (IUI) and in-vitro fertilization (IVF) are preferable options.

Fertility outlook after treatment

Although there is no guarantee of improvement of fertility and pregnancy outcome in endometriosis treatments, a research reported an overall pregnancy rate of 41.9% among women who had undergone endometriosis surgery with medical treatment within one year post surgery.

Even though endometriosis potentially can reduce the quality of eggs to be harvested during IVF, another study shows no difference between pregnancy rates and live births in women who had IVF due to endometriosis and other women without endometriosis who underwent similar procedure.