Endometriosis, fertility and pregnancy

If you have endometriosis, you’ve probably asked yourself the question, “Will endometriosis affect my ability to get pregnant?”

Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe endometriosis, natural conception is still possible.

How does endometriosis impact on fertility?

Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe endometriosis, natural conception is still possible. It is estimated that 60-70% of women with endometriosis can get pregnant spontaneously[1].

Due to a lack of research, the links between fertility and endometriosis are not fully known. In some cases it may be because the disease distorts a woman’s reproductive organs.

The main factor affecting fertility for any woman is her age. A woman is born with a lifetime supply of eggs that undergo maturation monthly once she has reached puberty. Fertility rapidly declines after the age of 38 both due to the rate at which the egg sacs disappear from the ovaries accelerating and due to increased rates for miscarriage and chromosomal abnormalities.

For those with endometriosis who do experience fertility issues, a proportion will get pregnant after medical assistance, either surgery to remove endometriosis or through assisted reproduction technologies (ie IVF).

Does endometriosis cause problems in pregnancy?

There is scientific debate around whether ‘later’ pregnancy complications are increased due to endometriosis, however, there is not enough research at present to substantiate these claims.

Will surgery or having a laparoscopy increase my chances of falling pregnant?

For those with superficial endometriosis (where tissue attaches to the peritoneum) there is evidence that laparoscopic surgery leads to better pregnancy rates and it can improve the chances of becoming pregnant naturally if you have had problems conceiving.

For those with deep endometriosis (where the bowel, bladder or ureter is involved) there has been little research on the effect of surgery on pregnancy rates.

Will I still experience endometriosis pain whilst I am pregnant?

In general, pain improves, but may return after giving birth as periods return. There are reports of people who had more pain in the first few months of pregnancy.

Does pregnancy cure endometriosis?

No, and pain can return after giving birth as your period returns.

Does endometriosis increase the likelihood of having a miscarriage?

Sadly, miscarriage is a common problem in all pregnancies, regardless of whether or not you have endometriosis. Miscarriage occurs in around 1 in 5 pregnancies, and if you have endometriosis, the risk increases to around 1 in 4.

Does endometriosis increase the likelihood of ectopic pregnancy?

Ectopic pregnancies are less common than miscarriages, with around 1 in 80 to 100 pregnancies ending up as ectopic. But, research has shown that in people with endometriosis, the risk is more than doubled.

What fertility support is available on the NHS for those with endometriosis?

There are NICE Guidelines in place to support those with endometriosis who are either experiencing fertility problems or where fertility is a priority, to best determine what treatment pathway should be followed. NICE Clinical Guideline: Fertility problems: Assessment and Treatment [CG156] state that the following process should be followed if you have diagnosed endometriosis:

  • Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment where: the woman is aged 36 years or over; there is a known clinical cause of infertility [such as endometriosis] or a history of predisposing factors for infertility.

NICE Guideline [NG73]: Endometriosis Diagnosis and Management[2] also highlights the baseline of fertility support that those with endometriosis should be provided with, and the treatment options you may wish to consider if fertility is a priority. For example, the Guideline states that if fertility is a priority, the management of endometriosis should have multidisciplinary team involvement with input from a fertility specialist. This should include recommended diagnostic fertility tests or preoperative tests and other recommended fertility treatments such as assisted reproduction.

If you are looking to get pregnant, or if fertility is a priority or concern, always talk to your GP or endometriosis specialist about this, so they can discuss with you your treatment and fertility options with you.

Access to IVF and other fertility services are down to individual CCGs and healthcare boards/trusts, so you will need to discuss this individually with your healthcare practitioner.

Useful links:

Fertility

Royal College of Obstetricians and Gynaecologists (RCOG): https://www.rcog.org.uk/en/patients/fertility/

Human Fertilisation and Embryology Authority (HFEA): https://www.hfea.gov.uk/

Fertility Network UK: https://fertilitynetworkuk.org/

Baby loss charities:

Tommy’s: https://www.tommys.org/

Petals: https://petalscharity.org/

Miscarriage Association: https://www.miscarriageassociation.org.uk/

Endometriosis and Fertility Webinars 

In this webinar, we are joined by Dr Daphne Chong, Subspecialist Fellow in Reproductive Medicine & Senior Specialist Registrar in Obstetrics and Gynaecology and Dr Chiara Achilli, Consultant Gynaecologist with special interest in Reproductive Medicine, from the Hewitt Fertility Centre at Liverpool Women's Hospital.

Mr Dimitrios Mavrelos, Consultant in Reproductive Medicine at UCLH, presents information on endometriosis and fertility. 
 

 

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