Getting Pregnant with Endometriosis? Yes, It Is Possible!

<blockquote> <h3>Fast Facts</h3> <ul> <li>About 1 in 10 women between the ages of 15 and 40 suffer from endometriosis – a painful reproductive issue that can negatively impact fertility. That’s an estimated 190 million American women.</li> <li>Endometriosis occurs when the tissue lining your uterus (the endometrium) grows where it’s not supposed to, like outside or behind your uterus, or around your ovaries, fallopian tubes, bowel, and bladder.</li> <li>Having endometriosis can compromise your fertility: around 30% of women with the condition have trouble getting pregnant.</li> <li>About 20% to 25% of women with endometriosis are asymptomatic; however, most (75% to 80%) of women will experience one or more symptoms, such as extra-heavy periods, ultra-painful period cramps, discomfort or pain during or after sex, and pain with urination and bowel movements during menstrual periods.</li> </ul> </blockquote> <p>Unlike peanut butter and jelly or Romeo and Juliet, endometriosis and pregnancy aren’t the best of pairings. In fact, with endometriosis being one of the three major causes of female infertility, they are often thought to not co-exist.</p> <p>Even if you’re one of the lucky ones who has managed to avoid the extremely unpleasurable symptoms – such as extra-heavy periods, ultra-painful period cramps, and discomfort or pain during or after sex – you might still find it impacts your fertility.</p> <p>The good news is that many women with endometriosis – as many as 70% – do go on to get pregnant and deliver healthy, happy babies. The other 30% of women may need more time or more treatments, but either way, pregnancy can happen.</p> <p>So, if you’re one of the 10% of women with endometriosis and you’re wondering how your condition may impact fertility and pregnancy, read on to find out.</p> <h2>Endometriosis, when tissue grows where it shouldn’t</h2> <p>Let’s take a trip back to sex ed class, where you learned all about the female reproductive system. As you’ll recall, the lining of the uterus is known as the endometrium. The endometrium is not like any other tissue in your body. Each month, when your estrogen and progesterone levels rise during ovulation, your endometrium responds by thickening in preparation for possible implantation of a fertilized egg. But if conception doesn’t happen, it sloughs off and causes bleeding, which is why you get your period. Your period is essentially dead, sloughed off endometrial tissue.</p> <p>Now, when a person has endometriosis, endometrial-like tissue grows outside the uterus in places it shouldn’t, such as:</p> <ul> <li>In front of the uterus, called anterior cul-de-sac, which is the space between the uterus and bladder</li> <li>Behind the uterus, called posterior cul-de-sac, which is the space between the uterus and rectum</li> <li>Near the ovaries</li> <li>Near the fallopian tubes</li> <li>Near the intestines</li> <li>Near the bladder</li> <li>Near tissues that line the pelvic cavity</li> </ul> <p>When endometrial-like tissues are found outside of the uterus, it is known as an endometrial implant. While it is rare for endometrial-like tissue to spread beyond your pelvic region, it can happen in severe cases of endometriosis.</p> <figure><img alt="Endometriosis" src="https://cdn.storymd.com/optimized/voJVgnTvo4/thumbnail.jpg" /> <figcaption>Endometriosis. <em>Source: BruceBlaus</em></figcaption> </figure> <h2>What causes endometriosis?</h2> <p>What exactly causes endometriosis is still not certain, but there are several theories:</p> <ul> <li>Retrograde menstruation, which happens when menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of leaving the body through the vagina</li> <li>Reproductive hormones transform the cells outside of the uterus into endometrial cells</li> <li>Leaking of menstrual blood into the pelvic cavity through an opening or surgical scar, such as after having a caesarean section</li> <li>Endometrial cells inside the uterus are transported out through the lymphatic system</li> <li>Genetics – endometriosis is thought to be polygenic, meaning that multiple genes contribute to its development. These genes are more prevalent in certain racial groups such as Hispanics and Asian women, who are 50% more likely to develop the condition than Caucasian or African American women.</li> </ul> <p>Additionally, there are certain factors that can make it more likely for a woman to develop the condition. So, your chances for endometriosis go up if:</p> <ul> <li>You’re in your 30s or 40s</li> <li>Your mom, sister, aunt, or daughter has it</li> <li>You have heavy periods that last more than 7 days</li> <li>Your periods are less than 27 days apart</li> <li>You started your period before you were 11-years-old</li> </ul> <h2>Your reproductive hormones drive your endometriosis</h2> <p>Just like the endometrial tissue inside your uterus, the hormonal changes during ovulation also affect the misplaced endometrial-like tissue. So, during your menstrual cycle when hormones rise, the endometrial tissue on your ovaries, bladder, or any other place it’s found, will begin to grow and thicken, causing these areas to become inflamed and painful. Eventually, the endometrial-like tissue will slough off, which can also cause pain – in some cases, severe and excruciating pain.</p> <p>Unlike inside your uterus, where the endometrium that sloughs off can exit your body through your cervix and vagina as menstrual blood, the misplaced endometrial-like tissue that sheds in other locations has nowhere to go, causing it to become trapped in your pelvis. This trapped dead tissue in your pelvis can cause:</p> <ul> <li>Severe irritation</li> <li>Scar tissue formation</li> <li>Adhesions, where the sloughed off endometrial-like tissue binds your pelvic organs together</li> <li>Severe pain that occurs during your menstrual cycle</li> <li>Fertility issues if your endometriosis affects your ovaries and/or fallopian tubes.</li> </ul> <p>However, it’s important to note that, while many women with endometriosis will experience some level of pain, the amount of pain one feels does not necessarily correlate to the severity of the condition. Meaning that you could experience off-the-chart-levels of pain but only have a mild case of endometriosis.</p> <h2>Mild, moderate, or severe: what are the stages of endometriosis?</h2> <p>The tricky thing about endometriosis is that it is a highly variant disorder – some women will experience mild symptoms, some will have severe symptoms, and others may have mild symptoms one month and severe the next. Because of the condition’s variability in symptoms, the American Society of Reproductive Medicine (ASRM) came up with a revisedclassification system, known as rASRM I-IV Staging System, to help doctors diagnose endometriosis. Depending on the severity of a woman’s endometriosis, she can be categorized in one of four stages. Each stage is determined based on the number of endometrial implants, how deep the implants are, and whether cysts or scarring are present.</p> <p>Here are the four stages of endometriosis that describe the severity of a woman’s condition:</p> <ul> <li><b>Stage I: </b>This stage is considered “minimal” endometriosis because endometrial implants are small, shallow, and few in number.</li> <li><b>Stage II:</b> This stage is considered “mild” endometriosis because there are more endometrial implants, as well as deeper ones than those found in patients with Stage I.</li> <li><b>Stage III:</b> This stage is considered “moderate” endometriosis. During this stage, women may experience a combination of deep endometrial implants and endometrial cysts on one or both ovaries. Women who have Stage III endometriosis may also have adhesions, which are thin bands of tissue that have bound their organs together.</li> <li><b>Stage IV:</b> This stage is considered “severe” endometriosis. Women in this stage will have deep endometrial implants, large cysts, and several dense adhesions throughout their pelvic regions.</li> </ul> <p>There are other classification systems, such as Enzian classification, endometriosis fertility index (EFI), American Association of Gynecological Laparoscopists (AAGL) classification, and others; however, the rASRM Staging System isthe one that many physicians use in the United States.</p> <h2>Endometriosis can be painful, cause heavy bleeding, or no symptoms at all</h2> <p>Because every woman’s body is different, not every woman with endometriosis will experience the same symptoms. In fact, about 20% to 25% of women with endometriosis show no symptoms at all. But for the 75% to 80% of women with the condition, they will likely experience one of more of the following symptoms:</p> <ul> <li>Abnormal or extremely heavy menstrual bleeding</li> <li>Discomfort or pain during sexual intercourse</li> <li>Debilitating pain the lower back or abdomen during ovulation</li> <li>Pain with urination and bowel movements during menstrual periods</li> <li>Chronic fatigue</li> <li>Leg pain during menstrual periods</li> <li>Gastrointestinal problems during menstrual periods, such as constipation, diarrhea, and nausea</li> </ul> <h2>How does endometriosis affect fertility</h2> <p>First of all, having endometriosis doesn’t mean you can’t get pregnant on your own; however, having endometriosis does mean that it can increase the chances of infertility. It’s not always clear why endometriosis makes it harder for some women with the condition to conceive, but scientists suspect that it has a lot to do with scar tissue.</p> <p>Going back to sex ed class again, natural pregnancy happens when an egg is released from the ovary during ovulation, which then travels down the fallopian tube to the uterus for it to be fertilized by a sperm before implanting into the endometrium (uterine lining).</p> <p>For some women with severe endometriosis, the rogue endometrial-like tissue implants can cause significant scarring around the ovaries and fallopian tubes. This can damage the ovaries, preventing the release of an egg, or can block the eggs' access to the fallopian tubes. In either case, it prevents the egg from reaching the uterus for that crucial meeting with the sperm for conception to happen. Endometrial implants can also cause scar tissue inside the uterus, which then prevents a fertilized egg from implanting in the endometrium.</p> <p>In milder cases of endometriosis, it can cause inflammation in the pelvic area, which can damage an egg or sperm celland/or interfere with the delicate balance of reproductive hormones that is needed to become pregnant.</p> <h2>Endometriosis and pregnancy: can it happen?</h2> <p>The simple answer is yes. Getting pregnant when you have endometriosis is possible, but it may be difficult. There are some potential treatments that may increase your chances of conceiving, such as:</p> <ul> <li><strong>Medications</strong>, like progestin injections (which help boost the level of pregnancy hormones in your body) or Clomid® (which help your ovaries produce two to three mature eggs each ovulation cycle).</li> <li><strong>Surgery </strong>to remove the endometrial implants without damaging the reproductive organs. Laparoscopic surgery, a minimally invasive surgery guided by a laparoscope (a long, thin tube with a camera at the end) is inserted through the belly button and uses lasers to remove the ‘out of place’ tissue. Even if successful, this procedure can sometimes cause scarring, which can affect ovarian or fallopian tube function.</li> <li><strong>Fertility treatments</strong>, such as <i>in vitro </i>fertilization (IVF) and intrauterine insemination (IUI)</li> <li><strong>Freezing eggs</strong> to preserve their quality for later. Since endometriosis can affect the eggs remaining in your ovaries, retrieving and freezing your eggs could be a good option.</li> </ul> <figure><img alt="Cryopreservation of mature oocytes" src="https://cdn.storymd.com/optimized/1dmwabuLAp/thumbnail.jpg" /> <figcaption>Cryopreservation of mature oocytes (freezing eggs). <em>Source: Ye M, Yeh J, Kosteria I and Li L (2020) Progress in Fertility Preservation Strategies in Turner Syndrome. Front. Med. 7:3. doi: 10.3389/fmed.2020.00003</em></figcaption> </figure> <h2>Pregnant with endometriosis: what can happen?</h2> <p>Congratulations! You’re over the first hurdle. But now that you’re pregnant with endometriosis, it does mean a ‘high-risk’ pregnancy.</p> <p>Being pregnant with endometriosis does increase the risk of miscarriage in early pregnancy. While it’s not exactly a case of cause-and-effect, studies have shown that women with endometriosis have a higher-than-average chance of experiencing a miscarriage.</p> <p>Later in pregnancy, you might also have an increased risk of preeclampsia (a serious condition in which you develop high blood pressure during pregnancy), placenta previa (a condition in which the placenta completely or partially covers the opening of the cervix, which can affect delivery), and preterm birth.</p> <p>However, that’s not to say that endometriosis and pregnancy are a recipe for loss or bad outcomes. With careful prenatal monitoring and extra care, many women with endometriosis experience no complications during pregnancy and deliver healthy babies.</p> <h2>More on Endometriosis</h2><ul><li><a href="https://soulivity.storymd.com/journal/7m7ao4aupm-endometriosis" target="_blank">Endometriosis (Endo): Risk Factors, Symptoms, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/jaep8b6f4w-endometriosis-and-fertility" target="_blank">Endometriosis-Related Infertility: How Endometriosis Affects Fertility</a></li><li><a href="https://soulivity.storymd.com/journal/qj3584lcam-assisted-reproductive-technology" target="_blank">The Types of Assisted Reproductive Technologies (ART)</a></li></ul>