How To Get Pregnant With Endometriosis Fast

Getting pregnant with endometriosis is possible, although it may not be easy. In fact, up to half of the women with the disorder will have trouble conceiving. While there are medical options to explore if have endometriosis and want to get pregnant, they are often complex and costly with varying degrees of success.

Even so, many women with endometriosis do get pregnant and will tell that the joy of being a parent makes it worth all of the emotional and physical hurdles they've had to leap.

Verywell / Colleen Tighe

This article offers insights into the causes and risks of infertility in people with endometriosis and what can be done to help if you are diagnosed with this common and often painful disorder.

Causes

Endometriosis happens when tissues lining the uterus (womb) grow outside of the womb. It affects 10% to 15% of females of child-bearing age and can cause symptoms like pelvic pain, cramps, heavy bleeding, bleeding between periods, pain with sex, and pain with bowel movements.

A 2012 study from Yale reported that 30% to 50% of women with endometriosis are unable to conceive. Even those who are mildly affected are 48% less likely to get pregnant than women who do not have endometriosis.

Because endometriosis does not cause symptoms in up to 25% of cases, many couples who cannot conceive may only realize that endometriosis is involved when they see a fertility doctor.

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The exact cause of infertility in women with endometriosis can vary from one person to the next. In some cases, multiple causes are involved. Some of the more include:

Ovarian cysts: Endometriosis can cause tissues to spread into 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 bands of 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 making its way to the egg.
Egg quality: It has long been thought that endometriosis reduces the odds of egg implantation by changing tissues inside the womb. Most studies have found that this is not the case and 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. The irony, of course, is that symptoms of endometriosis are often controlled with hormonal birth control which prevents pregnancy.

Endometriosis also increases the risk of pregnancy loss. Studies have found that women with endometriosis are 60% more likely to have a miscarriage than those without. No one knows for sure why this is given that women with milder disease appear to be at greater risk than those with severe disease.

Recap

Endometriosis can prevent pregnancy in different ways. It can affect egg quality or cause adhesions and ovarian cysts that prevent fertilization or block implantation. Pain during sex can also make it difficult to conceive.

Staging and Infertility Risk

During the diagnosis of endometriosis, your doctor may refer to the stage of the disease. Staging is a way to describe the severity of your condition based on the location, amount, and depth of tissue overgrowth. The stages of endometriosis run from stage 1 for the mildest form of the disease to stage 4 for the most severe form.

As a general rule, women with stage 1 or 2 are more likely to conceive than women with stage 3 or 4. But, it's not always the case.

In some cases, women with stage 1 may have more trouble getting pregnant than someone with stage 3 or 4. The risk depends largely on which organs of the female reproductive system are affected and how.

Where staging does help is with planning. For example, a woman with stage 1 or 2 endometriosis may take a watchful approach and try to conceive on her own, while someone with stage 3 or 4 may opt to proceed directly to treatment.

Recap

Having stage 3 or 4 endometriosis may suggest that you will have more trouble getting pregnant, but this is not always true. Depending on which organs of the reproductive tract are affected, you may better chances than someone with stage 1 or 2. Speak with fertility specialist.

Trying Natural Pregnancy

If you've been diagnosed with endometriosis before you've even thought about getting pregnant, you may wonder if it's worth trying to conceive on your own before seeking treatment. The answer is simple: yes.

Of course, you should speak with a doctor first, but having endometriosis doesn't mean you can't get pregnant. Many women do, even some whose condition is advanced.

In such cases, 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 the timeframe, you should speak with a fertility specialist.

With that said, some women will go straight to a specialist, especially if they are older. After 35, natural fertility declines. For some, those six months may seem like time better spent under specialist care.

Assisted Treatment Options

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)

Fertility drugs alone are not typically used in women with endometriosis. They don't improve pregnancy rates all that much compared to those who try to conceive naturally.

Instead, intrauterine insemination (IUI) with fertility drugs is the typical starting point for women with stage 1 or 2 endometriosis. IUI is the 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 natural pregnancy.

In Vitro Fertilization (IVF)

If IUI does not work, the next step is in vitro fertilization (IVF). IVF involves the removal and fertilization of an egg outside of the body, after which the egg is implanted back 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 if a woman is over 35, has stage 3 or 4 disease, and has multiple risk factors for infertility (such as male infertility or 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 forms of infertility.

IVF is not an option for all couples. Some couples prefer less intensive treatments, while others simply cannot afford the cost of IVF. For these couples, multiple rounds of IUI may be advised as well as adoption or surrogacy.

Recap

Assisted fertility options include intrauterine insemination (IUI) and in vitro fertilization (IVF). Generally, IUI is the first-line choice as it is less invasive, though women with severe endometriosis, older age, or multiple infertility risk factors may opt for IVF first.

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 women with severe endometriosis, surgery does 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 outweigh any benefit in terms of improved fertility. You need to weigh the pros and cons with a surgeon to make a fully informed choice.

Recap

Endometriosis surgery is mainly used to treat pain but may improve the odds of pregnancy in some women. Even so, it is not advised in women with no pain as the benefit is likely small.

Summary

Up to 50% of women with endometriosis have difficulty getting pregnant. The causes are many, including poor egg quality and adhesions or ovarian cysts that block fertilization or implantation. Women with stage 1 or stage 2 tend to have a better chance of getting pregnant than women with stage 3 or 4, but this is not always the case.

Based on many factors, including age and the stage of endometriosis, the doctor may advise you to try getting pregnant naturally for six months. If that does not work, other options are available, including intrauterine insemination (IUI) or in vitro fertilization (IVF). Surgery may improve the odds of pregnancy but the benefit is likely small compared to the risks.

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 and they represent minimal, mild, moderate, and severe. These stages are classified based on location, quantity, and depth of the endometrial tissue.