Fertility

Last updated 13 February 2017 — Last reviewed 07 October 2016

About one third of women with endometriosis have trouble with fertility and struggle to get pregnant. This is likely to affect women in different ways and can create a rollercoaster of emotions. Once pregnant, many women also worry about the effect of their endometriosis on their pregnancy and delivery.

Endometriosis, fertility & pregnancy

About 30% of women with endometriosis have trouble getting pregnant. It is thought that the reasons are related to:

  • scarring of the tubes and ovaries from endometriosis
  • problems with the quality of the egg
  • problems with the embryo travelling down the tube and implanting in the wall of the uterus due to damage from endometriosis
  • change of the organs in the pelvis such as adhesions with scarred pelvic tissue and blockage of the fallopian tubes

endo and pregnancy

It is important to remember not all women with endometriosis are infertile. Many women have children without difficulty, have children before they are diagnosed, or eventually have a successful pregnancy.

Laparoscopic surgery (keyhole surgery using a thin telescope with a light inserted through a small cut in the belly button to look into the pelvis) is an operation to reduce symptoms and improve fertility by removing endometriotic patches, implants, cysts, nodules and adhesions by cutting them out (excision) or burning them (diathermy).

If treatment is unsuccessful, in vitro fertilisation (IVF) treatments may also be considered. However, before trying this form of treatment, it is important that your endometriosis is properly treated. IVF treatment includes increasing oestrogen levels, which will encourage the development of existing endometriosis.

Please visit our webpages on fertility if you would like more information.

Feelings

The effect of having endometriosis and troubles with fertility may cause different feelings such as:

  • worry
  • confusion
  • feelings of inadequacy
  • anger
  • stress
  • sadness
  • depression
  • grief

Some women with endometriosis feel pressured to have children as soon as possible to increase their chances of becoming pregnant. You may feel overwhelmed because you don't feel ready to have children, or you want to have a child but you:

  • do not have a partner
  • have not been in the relationship for long
  • are with a partner who is not ready to have children

Other women may be ready to have children but can't get pregnant and as a result and have feelings of frustration, hopelessness and may be more prone to depression.

It is often during investigations to see why you are not getting pregnant that the diagnosis of endometriosis is made. In 30% of women who are having difficulty becoming pregnant, endometriosis is the cause. So any distress over trying to get pregnant may be increased by the stress and shock of the diagnosis of endometriosis.

Talking to a doctor, counsellor or psychologist can help you to cope with these feelings and help you to decide what to do next.

Fertility treatments & feelings

Starting on fertility treatment can lead to a range of different feelings from happiness and excitement to frustration, disappointment and sadness.

If you decide to try fertility treatment, it is important both you and your partner are supported through the process. Most IVF units will have counsellors who will support and counsel you through the assessment and treatment time. Getting counselling before starting treatment can help you to:

  • prepare for the emotional journey ahead
  • cope with any unsuccessful treatments or miscarriages
  • develop strategies for coping with other people's pregnancies/births
  • talk through how both you and your partner are feeling throughout the process

Endometriosis, pregnancy & delivery

Recent studies have shown if you have endometriosis, medical care should not stop once you become pregnant. Endometriosis is a risk factor for:

  • the baby being born early – before 40 weeks
  • bleeding after the 24th week of pregnancy
  • high blood pressure (pre-eclampsia)
  • delivery by caesarean section

Endometriosis & the risk of premature birth

If you have ovarian cysts (endometriomas) and become pregnant using assisted reproductive technologies (ART), there is a greater risk of the baby:

  • being born early – before 40 weeks (preterm birth)

A large study of more than 13,000 births, showed that women who were diagnosed with endometriosis had a higher risk of complications at birth, preterm birth and of having a caesarean section [1]. This research information helps obstetricians identify and monitor pregnant women who have been diagnosed with endometriosis at increased risk of premature labour and birth.

Effect of pregnancy on endometriosis

Pregnancy does not cure endometriosis, but symptoms appear to improve during pregnancy. This is because higher progesterone levels can suppress the endometriosis. However, the effects of endometriosis after delivery of the baby are unclear. These effects may only be temporary and many women have a recurrence within a few years.

References

  1. Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis assisted reproduction technology, and risk of adverse pregnancy outcome. Human Reproduction. 2009;24(9): 2341-7. 

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at October 2016.

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