Is Endometriosis Affecting Fertility?

Endometriosis is a chronic condition that affects 11 percent of women in the United States, particularly those in their 30s and 40s. It occurs when tissue that belongs in the lining of the uterus grows in other areas of the body, such as the ovaries, fallopian tubes, intestines, and even in the thoracic region. These growths can swell and bleed, block fallopian tubes, form scar tissue and adhesions, and affect your intestines and bladder.

Endometriosis can be associated with these symptoms:

• Painful menstrual cycles
• Chronic pelvic pain with or without your menstrual cycle
• Pain with sexual intercourse
• Infertility
• Digestive symptoms (bloating, painful defecation, straining with stools, rectal bleeding or constipation)
• Urinary symptoms (painful urination, blood in the urine, UTI and/or urinary frequency)

If you have endometriosis, you may have some or all of these symptoms, and the severity varies with each person.

Endometriosis and Fertility

Endometriosis can affect fertility in several ways. The number of growths has been linked to the ability to conceive, but that’s not always the case.

The different stages of this chronic condition relate to the number of endometrial growths and how they may have affected or distorted a particular area. For example, a severe case of endometriosis can distort and/or change the orientation of your pelvic anatomy. Pelvic adhesions can directly impact fertility by impairing oocyte release during ovulation. Those adhesions also can alter the motility of the sperm and impair the fertilization and transportation of the embryo.

Stages of infertility include:

Stage I: Minimal endometriosis has a few superficial growths.

Stage II: Mild endometriosis has more and deeper growths.

Stage III: Moderate endometriosis has many deep growths, small cysts on one or both ovaries and filmy adhesions.

Stage IV: Severe endometriosis has many deep growths, large cysts on one or both ovaries and many dense adhesions.

If you have endometriosis and are trying to become pregnant, your doctor will ask questions during your physical exam that will help determine how endometriosis may play a role in your ability to conceive.

Treatment of Infertility Related to Endometriosis

Several different treatment options are available for endometriosis, including anti-inflammatory medication, oral or injectable medication and surgical options. You and your doctor can decide what is the best treatment option based on what you have tried and the level of severity of the endometriosis. 

If you’ve been diagnosed with endometriosis and have had difficulty getting pregnant, visit your physician to ensure there is no other factor that could be affecting fertility. Depending on your stage and symptoms of endometriosis, surgical intervention may be needed to help you conceive. If, for example, your anatomy is distorted or there is a cyst on the ovaries or extensive pelvic adhesions, surgery may be the best way to improve fertility.

Additional treatment options for infertility related to endometriosis include ovulation induction, artificial reproductive technology or artificial insemination.

Symptoms of endometriosis also can overlap with other gynecological symptoms, so make sure to always alert your doctor of any concerns. Remember that not all women with endometriosis have the same symptoms, level of severity or difficulty starting a family, so talk with your doctor about your symptoms and together you can determine the best plan for conceiving.