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Endometriosis frequently causes infertility, though many patients are indeed able to conceive naturally. When do you need to start thinking about seeking medical attention, and what are the treatment options that make getting pregnant more likely for you?

Endometriosis — an inflammatory condition in which the lining of the uterus proliferates outside of it as well — can affect the ovaries and fallopian tubes, thereby blocking released eggs' path to the uterus and causing infertility. Depending on which statistics you go by, as many as half of all women with the condition may have trouble conceiving. Though endometriosis often causes a variety of symptoms, the main one of which is pelvic pain (especially during menstruation), some women are asymptomatic. In that case, a woman may first discover she has endometriosis when she seeks medical attention after unsuccessfully trying to get pregnant.

Studies indicate that endometriosis is present in women struggling with infertility eight times as often compared to women who do not face fertility problems, but that doesn't mean it is impossible to conceive with endometriosis.

Factors that influence your ability to get pregnant women endometriosis include:

  • The severity and extent of your endometriosis
  • Your age
  • Whether your partner is fertile

Why does endometriosis interfere with fertility?

The exact causes of infertility are not the same in each endometriosis patient, as any of these factors, or a combination of them, can play a role:

  • Scar tissue formation in the ovaries, the fallopian tubes, and the fimbria (which transport eggs to your tubes) — this can both prevent egg and sperm from meeting and stop eggs from traveling down to the uterus
  • Poor egg quality
  • Fertilized eggs fail to implant into the uterus

Do I have any hope of getting pregnant naturally with endometriosis?

Yes, you do. The grimmest statistics indicate that around half of all endometriosis patients will have trouble conceiving, and the other side of that coin is that at least half will be able to get pregnant without any problems. Your chances of getting pregnant naturally are likely to be better if you have milder endometriosis (stages 1 and 2). 

If you are are younger than 35, it makes sense to try to conceive naturally for at least six months before seeking medical attention, though even in this case, there is nothing wrong with letting your OBGYN know you're hoping to conceive and discussing your options. Women over 35 who have already been diagnosed with endometriosis, meanwhile, also have a slightly lower chance of conceiving naturally due to their age. If this is you, deciding to discuss options that make getting pregnant more likely with your doctor immediately is a valid choice.

Trying to conceive and endometriosis treatment

Hormone therapies, including hormonal contraceptives, are often employed as an endometriosis treatment that lessens pain. These contraceptives are, of course, unsuitable for women who would like to start trying to conceive. It's a good idea for any woman to have a preconception checkup before trying to conceive, but endometriosis patients should also discuss the way in which coming off birth control may impact their symptoms. 

What treatments can boost your chances of conceiving with endometriosis?

Invitro fertilization will offer any woman suffering from infertility as a result of endometriosis the best odds of getting pregnant. Not only is IVF incredibly expensive, however, the pharmacological regimes associated with the IVF treatment will also increase your levels of estrogen — which is in turn likely to result in a worsening of your endometriosis. Starting with IVF is not, then, the best approach for most patients.

Depending on the extent of your endometriosis, your age, and your partner's fertility, your doctor is likely to suggest you start with intrauterine insemination in combination with gonadotropins or Clomid to induce ovulation. Clomid is the most frequently used medication, as it is associated with a lower risk of ovarian hyperstimulation syndrome and twin pregnancies. This treatment option is especially suitable for women with Stage 1 or Stage 2 endometriosis. Fertility medications are not usually prescribed as a stand-alone treatment as it doesn't increases your odds of conceiving that much.

Surgery to remove extrauterine endometrial lesions (often carried out through laparoscopy) is another treatment option for endometriosis patients who are hoping to conceive, as research shows that this surgery increases patients' odds of achieving a pregnancy. This surgery is also performed in order to reduce pain, and while it is especially likely to improve fertility in women with Stage 1 or Stage 2 endometriosis, Stage 3 and 4 patients with ovarian cysts may find that the surgery has a negative impact on their ovarian reserve. This is why those patients aren't advised to undergo this surgery again if they didn't get pregnant after an initial operation — for these women, IVF is a better option. Do note that any kind of pelvic surgery also increases the risk of adhesions, because surgery causes scar tissue formation. 

IVF is usually recommended after other treatment options have unsuccessfully been explored. For older women with endometriosis (over 35, and especially over 40), women with Stage 3 or Stage 4 endometriosis, and couples who have additional infertility struggles besides endometriosis (male factor infertility, for instance), IVF can also be the first point of call, however. Some women with milder endometriosis also simply prefer to opt for IVF due to its higher chances of conception. Discuss the benefits and risks of IVF with your doctor before making a decision.

How effective are fertility treatments for endometriosis?

  • One study indicated that women who underwent surgery to remove endometriosis lesions and those with suspected but unconfirmed mild endometriosis had a 9.5 percent chance of getting pregnant during any one intrauterine insemination/Clomid cycle. The control group, which practiced timed intercourse, had a much lower pregnancy rate at just over three percent.
  • Another study looked into pregnancy rates among endometriosis patients undergoing IUI in combination with gonadotropins, comparing their results to patients who continued to try to conceive naturally. This study found that 15 in 100 women in the IUI/gonadotropin group got pregnant, compared to 4.5 percent of the control group.
  • Research shows that women with endometriosis who undergo IVF have a per-cycle pregnancy chance of just over 22 percent — making IVF less successful in endometriosis patients than those who have the treatment for many other reasons, but much more successful than IUI.

Are women with endometriosis more likely to suffer miscarriages?

Research indicates that endometriosis patients have a much higher risk of miscarriage than women without endometriosis — 35 percent vs 22 percent. One unexpected surprise is that the study found that women with Stage 1 and Stage 2 endometriosis are actually at a higher risk of miscarriage (42 percent) than those with more severe endometriosis (31 percent). 

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