Endometriosis and Fertility

Endometriosis is one of the common conditions linked to infertility, with 10% to 30% of people diagnosed with endometriosis experiencing infertility. For people with endometriosis, the experience of infertility can add to the burden of endometriosis by contributing to challenges in your relationships, in social settings, and even financially (due to the cost of fertility treatment). It can also increase feelings of hopelessness and adversely impact your mental health.

If you have endometriosis, it can be more difficult to become pregnant. The reasons why are not fully understood, but may be because of:

  • pelvic adhesions and scar tissue that fuse organs and ligaments together and block ovaries and/or fallopian tubes;
  • chronic inflammation that impacts embryo implantation or ovulation;
  • changes to the shape of the reproductive organ;
  • or hormonal imbalances.

For people with endometriosis, it can be difficult to think about family planning. For those that experience chronic pain, you may feel like you need to make the choice between managing pain and family planning. You may also feel pressured to make choices about your family planning before you are ready because you are concerned that you are infertile. It is important to speak to your health care provider about your family planning and long-term goals.

Can I Still Get Pregnant if I Have Endometriosis?

If you have endometriosis, it can be more difficult to become pregnant; however, many people with endometriosis or endometriosis-related infertility can still get pregnant and successfully carry to term.

Fertility treatment options may include time and assisted reproduction techniques (including oral or injectable fertility medicines, in vitro fertilization, or intrauterine insemination). In some cases, you may be advised to have surgery to remove endometriosis growth and scar tissue. This is normally done laparoscopically using methods known as ablation (removal of endometriotic tissue by scraping or burning the tissue) or excision (removal of the tissue by cutting out the whole lesion). Surgery should be performed by a gynaecologist with special training in endometriosis.

Dealing with both endometriosis and infertility can have an impact on your physical, mental, and social health. If you have or suspect you have endometriosis, it is important to speak with a health care provider about your health, family planning, and long-term goals.

What Endometriosis Management Options are Safe During Pregnancy?

Some people may find relief from their endometriosis symptoms during pregnancy because of a surge of progesterone, but feelings of relief are not universal. Every experience during pregnancy and with endometriosis is unique.

While there is no cure for endometriosis, there are many different treatment options that can help stop disease progression and manage your symptoms. If you are pregnant or planning to become pregnant, talk to your health care provider about the best options for your own health as well as the health of your developing baby. You may need to try a few options to see what works best for you.

Medical Management

For individuals using hormonal (e.g., the birth control pill or an intrauterine device) or medical management options (e.g., non-steroidal anti-inflammatory medications, anti-depressants, cannabis, opioids) pre-pregnancy, it is important to speak to your health care provider about their safety for use during pregnancy. It is recommended to stop using hormonal or medical management options before you are pregnant or planning to become pregnant.

Surgical Management

As many hormonal and medical management options will be unavailable if you are pregnant or planning a pregnancy, surgical management to help remove lesions caused by endometriosis

may be recommended. There are several techniques that can be used during surgery to remove endometriotic growths and scarring. The methods you and your health care provider choose will be based on how extensive your endometriosis is and where it is located. Ablation is the removal of tissue by scraping or burning the tissue. While this technique can be helpful in removing superficial lesions, it may not be possible to remove all the tissue. Excision is the removal of tissue by cutting the whole lesion, which is why it is often the chosen technique for deeply invasive endometriosis or endometriosis involving other organs.

Surgery is not effective for everyone. Surgery should be performed by a gynaecologist with special training in endometriosis. While some people may see symptom improvement after surgery, endometriosis may return for others. As all surgeries have some amount of risk, surgery is not recommended for everyone with endometriosis, including as a fertility treatment option.

Additional Endometriosis Management Options

Depending on affordability, comfort, availability in your region, and your beliefs and values, there may be additional endometriosis management options available to you. These may include:

  • Heat: A hot water bottle, heating pad, or hot towel on your abdomen or lower back can be helpful.
  • Transcutaneous electrical nerve stimulation (TENS): A small device that sends an electrical current across the skin and to the nerves. TENS units are mostly portable and come with several settings so you can adjust the frequency of pulses, the duration of each pulse, and the intensity of the pulse.
  • Physiotherapy: Particularly with a focus on pelvic health, physiotherapy can help strengthen the pelvic floor muscles. A physiotherapist can also suggest relaxation techniques and exercises to reduce pain and manage pain.
  • Counselling: Can help build mindfulness techniques to help reduce stress and chronic pain, give you tools to calm the nervous system, and help manage anxiety, depression, and other intense emotions and grief that can emerge from pain-related losses.

Other lifestyle considerations including diet and exercise may be helpful to reduce some of the symptoms you experience. There is no one diet or exercise routine that works for everyone. Increasing your intake of fruits and vegetables, eating fish a few times per week, and reducing animal and alcohol intake may be beneficial. Exercising can also be beneficial and help improve your health overall so that your body is better able to deal with the stress it experiences from endometriosis.

There may be other techniques that work for you. For instance, acupuncture and massage therapy may also be beneficial. It is helpful to explore diverse pain management options and reflect on the options that help improve pain and endometriosis symptoms as well as those that make your symptoms feel worse.