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Does Endometriosis Cause Infertility​?

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Does Endometriosis Cause Infertility?

Endometriosis affects millions of women and can pose challenges, especially during reproductive years. If you’re living with endometriosis or suspect you might have it, you may wonder how it could impact your ability to conceive.

While studies show a link between endometriosis and infertility—affecting up to 50% of women facing infertility—remember that not everyone with endometriosis will experience these issues.

Learn how endometriosis impacts fertility, available treatments, and steps to help maximize your chances of conception.

What is Endometriosis?

Endometriosis is a medical condition in which tissue similar to the lining of the uterus (called the endometrium) starts growing outside the uterus. This tissue behaves like regular uterine tissue, thickening and breaking down with each menstrual cycle. However, unlike menstrual blood that exits the body, this misplaced tissue cannot leave. This results in inflammation, scar tissue, and adhesions. Over time, these changes can affect reproductive organs, impacting fertility.

Common Symptoms

Common Symptoms of Endometriosis include:

  • Chronic Pelvic Pain: Often severe, pelvic pain can interfere with daily activities.
  • Pain During Menstrual Periods: Women with endometriosis frequently experience intense pain and heavy bleeding during menstruation.
  • Pain During Intercourse: Pain during or after intercourse is also a common symptom and may affect quality of life.
  • Digestive Issues: Frequent complaints include bloating, nausea, and bowel discomfort.

The 4 Stages of Endometriosis and Infertility

Endometriosis is typically classified into four stages, from minimal (stage I)  to severe (stage IV), based on the extent of tissue growth and scarring. More advanced stages can pose greater fertility challenges, though even early-stage endometriosis can impact the ability to conceive.

  • Stage I: Involves small, superficial lesions.
  • Stage II: Has more and deeper lesions
  • Stage III: Includes deep implants with small cysts and some scar tissue
  • Stage IV: Features extensive lesions, large cysts, and dense adhesions, often affecting pelvic anatomy and fertility. 

It is important to remember that the condition’s severity may not always match symptom intensity.

What Percent of Infertile Women Have Endometriosis?

Studies estimate that endometriosis affects 25-50% of women facing infertility, making it a common cause of fertility challenges. Understanding this link can be crucial if you’re experiencing difficulties with conception. However, every case is unique—some women with mild endometriosis have no issues conceiving, while others with more advanced cases may still conceive naturally.

How Does Endometriosis Cause Infertility?

We are not 100% sure how endometriosis causes infertility, though there are a few theories. The condition is complex and often misunderstood, so working with a healthcare provider, even after diagnosis, is important to get proper guidance and support.

Distorted Pelvic Anatomy

Adhesions and scar tissue can alter the positioning of reproductive organs. For example, adhesions can bind the ovaries, fallopian tubes, or uterus to other structures in the pelvis,     obstructing the natural pathway for eggs to travel from the ovary to the uterus. 

Inflammation

The body’s immune response to endometrial tissue outside the uterus can cause inflammation, interfering with sperm and egg health. Chronic inflammation can also disrupt the environment necessary for a fertilized egg to implant successfully.

Hormones

A hormonal imbalance is a key issue with endometriosis. This imbalance invites immune cells, causing inflammation. The inflammation then triggers cell growth pathways that help these endometrial cells grow outside the uterus. The hormonal imbalance also interferes with ovulation, causing irregular menstrual cycles.

Egg Quality

Some research suggests that endometriosis can negatively impact ovarian reserve and egg quality, particularly when someone has stage IV endometriosis. This can reduce the chances of successful fertilization and may require assisted reproductive interventions.

Can You Get Pregnant Naturally If You Have Endometriosis?

If you have been trying to conceive for a while with no success, don’t give up hope. While endometriosis can make conception more challenging, many women with the condition can and do conceive naturally. Below are a few factors that may impact your fertility journey:

  • Early diagnosis–getting help sooner, along with an individualized treatment program, can significantly enhance your chances of conceiving naturally
  • Age: In a large, multi-year study of women with endometriosis, the risk increased if they were over the age of 35, though almost all women were able to successfully conceive before the age of 40. 
  • Lifestyle: You can make certain lifestyle changes, like researching an anti-inflammatory diet and tracking your ovulation cycle. 

For those with mild or minimal endometriosis, conceiving without medical intervention may still be possible. Discuss your unique situation with a Genesis OB-GYN provider, as individual cases vary significantly. Certain factors, such as age, overall health, and endometriosis severity, play a role in your likelihood of natural conception.

Endometriosis Infertility Treatment Options

If you’re dealing with fertility struggles due to endometriosis, several treatment options can help manage symptoms and boost your chances of conceiving. From hormonal treatments to surgery and assisted reproductive technologies (ART), you’ve got options. Let’s dive into the most common approaches.

Medications and Hormone Therapy

Hormonal treatments are often the first line of defense for managing endometriosis symptoms. While these medications can reduce pain, scar tissue and inflammation, studies indicate they do not significantly improve fertility. Some common medications and hormone treatments are:

  • Hormonal Contraception: Birth control pills can suppress ovulation and reduce symptoms but are not ideal for those actively trying to conceive.
  • GnRH Agonists: These medications temporarily suppress estrogen production, halting the growth of endometrial tissue. However, they may need to be combined with other treatments for optimal fertility outcomes.
  • Progestin Therapy: Progestins, or progesterone-like hormones, treat endometriosis by thinning the uterus lining and helping with lesions and scar tissue.

Surgery

Surgery can be a highly effective option for some women, particularly those with moderate to severe endometriosis. Procedures like laparoscopy or excision surgery aim to remove endometrial tissue and scar tissue, restoring a more natural pelvic anatomy. In one systemic review, the fertility rates after surgery were 35.7%, 44.4%, 53.3%, and 20.0% for stages I, II, III, and IV, respectively. 

Assisted Reproductive Technology (ART)

For women facing persistent challenges or those with severe endometriosis who have tried other methods, assisted reproductive technologies (ART) provide additional pathways to parenthood.

  • In Vitro Fertilization (IVF): IVF is a common and effective ART for women with endometriosis-related infertility. IVF bypasses some of the anatomical and hormonal challenges caused by endometriosis by fertilizing eggs outside the body.
  • Intracytoplasmic Sperm Injection (ICSI): ICSI, often combined with IVF, involves directly injecting sperm into an egg. This technique can be helpful in cases of male infertility or when other ART methods have not been successful.
  • Intrauterine Insemination (IUI): IUI, where sperm is placed directly into the uterus, can be an option for some women. However, its success rate may be lower for those with moderate to severe endometriosis compared to IVF.

When to See a Doctor

If you’ve been trying to conceive for 12 months (or six if you’re over 35), it may be time to consult your Genesis OB-GYN provider. Getting pregnant with endometriosis isn’t impossible, but you may need additional help. 

Early intervention and treatment can give you a better chance of managing symptoms and achieving your fertility goals. Book an appointment to explore your options with our team today!