Endometriosis: fertility and pregnancy

Endometriosis affects one in 10 women in the UK and can be a debilitating condition. It causes a range of symptoms including tummy and lower back pain and heavy periods. Endometriosis can also cause problems with fertility, which many women have concerns about. We spoke to fertility consultant Mr Ehab Kelada about some frequently asked questions.

What is endometriosis?

Endometriosis causes tissue, such as cells lining the womb, to grow in other places such as the fallopian tubes, ovaries, bladder and bowel. Each month during a period, the tissue breaks down just like it does in the womb, but there is nowhere for it to go. This can cause pain, inflammation and scar tissue. 

Who is affected by endometriosis?

The condition can affect women of any age during their reproductive years. Symptoms vary from person to person, with some having hardly any symptoms and others being very badly affected. It is a long-term (chronic) condition and the cause is often unknown. A number of things are thought to affect your likelihood of developing endometriosis including hormone levels, genetics, your immune system and environmental factors. 

How does endometriosis affect fertility?

Some women with moderate or severe endometriosis have scar tissue that blocks the fallopian tubes, stopping their eggs from travelling to the womb and therefore affecting their fertility. However, sometimes fertility can be affected by endometriosis even if the fallopian tubes are free of scar tissue. It’s thought that inflammation in the body caused by the condition may damage eggs or sperm.

Does endometriosis always affect fertility?

Although there is a connection between endometriosis and fertility issues, not every woman who has endometriosis will have trouble conceiving. Many women with mild endometriosis find they don’t have any problems conceiving. Moderate to severe endometriosis does reduce the chance of natural conception but doesn’t make it impossible. However, some women only discover that they have endometriosis because they have difficulty getting pregnant and consequently see a doctor to find out why. 

Does medication for endometriosis affect fertility? 

Many women are given hormone treatment for endometriosis, such as the contraceptive pill or an intrauterine device (IUD) that releases hormones. These treatments regulate the hormones that affect the build-up of tissue in endometriosis and also prevent pregnancy. If you’re trying to conceive you will need to stop these treatments and try alternative treatments.

Can surgery for endometriosis improve fertility?

Surgery for endometriosis can improve your chances of conceiving naturally or with fertility treatment. Usually, surgery is offered if you have pelvic pain and a cyst on your ovary. A laparoscopy may be carried out to remove the cyst. This is a type of keyhole surgery where a tube with a tiny camera is inserted through a small cut so the surgeon can see exactly what is going on inside your body and then through another small cut, the cyst and endometriosis tissue are removed. 

It is also possible to have tubal surgery to repair damaged fallopian tubes. The decision on whether surgery is suitable to improve your fertility will be made after considering lots of different factors including your age, the severity of your endometriosis, how many eggs you have and how long you’ve been trying to conceive.

Can women with endometriosis have fertility treatment? 

There are a number of different fertility treatments that are suitable for women with endometriosis. If you’re struggling to conceive naturally you should discuss treatments with a consultant specialising in fertility. The best treatment for you will depend on the severity of your endometriosis, your age, and other factors that may affect your fertility. In many cases, in vitro fertilisation (IVF), where your eggs are removed, fertilised and placed into your womb, is the most effective treatment, but there are other options.  

Does endometriosis affect pregnancy?

Although getting pregnant can take longer for a woman with endometriosis, once you have conceived the pregnancy should progress as normal. Some women find they have more pain to start with but many find that their pain improves while they are pregnant. Pain can return after the birth of your baby when your periods start again.

Women who are aware they have endometriosis and have become pregnant should make sure their doctor knows so they can look out for any possible complications, though these are uncommon. 

When should women with endometriosis see a fertility doctor?

If you have mild endometriosis there is no reason why you shouldn’t try to conceive naturally. If, after some time, you can’t conceive then it is a good idea to consult your doctor. If you have moderate to severe endometriosis you may want to see your doctor before trying to conceive to discuss your options. Your doctor may still suggest trying to conceive naturally at first, depending on how your endometriosis affects you.

Please note that not all Spire hospitals have a fertility department.