The journey towards motherhood is deeply personal and emotional, but the path to conception isn’t always easy. A challenge many women around the world face is endometriosis, a condition that affects the lining of the uterus and may have an impact on fertility. However, it’s important to know that it is still possible to achieve a healthy pregnancy with endometriosis.
In this article, we’ll answer your most pressing questions about infertility and endometriosis. We’ll cover topics such as common symptoms of endometriosis, the impact of endometriosis on fertility, and potential treatments for endometriosis infertility.
What is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the uterine lining grows outside the uterus, forming a type of abnormal scar tissue called endometrial implants1. These implants can show up in different reproductive organs, such as the ovaries, fallopian tubes, and the outer surface of the uterus. Endometriosis affects about 10% of women2 between ages 15 and 44 globally, although it’s more common in women in their 30s and 40s.
The abnormal scar tissue formed in endometriosis acts similarly to the normal uterine lining, thickening and breaking down with each menstrual cycle. However, unlike healthy uterine lining, the displaced tissue has no exit route, leading to inflammation, pain, and the formation of adhesions. The causes of endometriosis are still unknown, and there’s no known way to prevent it.
There are four main manifestations of endometriosis:
- Superficial peritoneal endometriosis – In this type of endometriosis, the endometrial tissue attaches to the peritoneum, a thin membrane that lines the abdomen and pelvis.
- Endometriomas – These are dark, fluid-filled cysts, also called ovarian endometriomas or “chocolate cysts.” They show up in different sizes and can appear in different parts of the pelvis or abdomen, but they’re most common in the ovaries.
- Deeply infiltrating endometriosis (DIE) – In DIE endometriosis, the endometrial tissue has invaded the organs either within or outside the pelvic cavity, which can include the ovaries, rectum, bladder, and bowels. In rare cases, the scar tissue can bond organs, making them become stuck in place.
- Abdominal wall endometriosis – Endometrial tissue can sometimes grow on the abdominal wall. The cells may attach to a surgical incision, like one from a C-section.
For those diagnosed with endometriosis, it’s possible to experience some challenges in conceiving. One study shows that the endometriosis infertility rate ranges between 30% to 50%3, but research is still being performed. So how does endometriosis cause infertility? This condition may lead to distorted pelvic anatomy, scarred fallopian tubes, adhesions, inflammation of the reproductive organs, altered hormonal and immune system functioning, poor egg quality, and impaired implantation.
If you’ve been diagnosed, don’t lose hope — an endometriosis diagnosis doesn’t mean you cannot get pregnant. In fact, it’s estimated that 60-70%4 of women with mild to moderate endometriosis can conceive without any treatment.
How is Endometriosis Diagnosed?
Diagnosing endometriosis usually involves a combination of medical history evaluation, clinical examinations, and imaging studies. While a definitive diagnosis can only be confirmed through a surgical procedure called laparoscopy, your doctor might suspect endometriosis based on your symptoms. To diagnose endometriosis, doctors may perform a number of tests, including:
- Medical history and symptom assessment – If your doctor suspects endometriosis, they’ll usually begin by conducting a thorough medical history interview to understand your symptoms and reproductive history. A detailed discussion about the nature, intensity, and duration of your symptoms will help in establishing a baseline for further evaluation. Your doctor may also ask about your family history. This is important because some studies show that when there’s a generational link, endometriosis can worsen from one generation to the next5.
- Physical examination – Your doctor may also perform a pelvic exam to check for any abnormalities, such as the presence of tender nodules or masses.
- Imaging studies – In some cases, imaging studies (such as ultrasound, CT scan, or MRI), may be used to visualize potential lesions.
- Diagnostic laparoscopy – This is the standard for confirming endometriosis. A laparoscopy is a minimally invasive procedure that involves inserting a thin, lighted tube through small incisions in the abdomen to visualize and take small samples of any suspicious lesions. Laparoscopy allows for both diagnosis and, in some cases, simultaneous treatment by removing endometriotic tissue.
- Biopsy – In a biopsy, the tissue samples obtained during laparoscopy are sent to a laboratory for further examination. This analysis can confirm the presence of endometrial-like tissue outside the uterus and helps distinguish endometriosis from other conditions.
Symptoms of Endometriosis
Every woman’s experience with endometriosis is different. In fact, some women don’t notice any symptoms at all. However, common symptoms of endometriosis include:
Pelvic pain is one of the most common symptoms of endometriosis. This pain can range from mild discomfort to severe, debilitating pain that doesn’t respond to over-the-counter (OTC) medications. The pain associated with endometriosis can occur before, during, or after your period, and it’s often felt deep within the pelvis. However, the intensity and location of the pain may vary widely between individuals with endometriosis.
While an irregular period certainly isn’t always a sign of endometriosis (most women will experience irregular periods at some point), it can be a symptom. You may notice that your period is shorter or longer than usual, or that you experience heavy menstrual flow, or spotting between periods. While it’s rare, some people with endometriosis may also have no periods at all. These period irregularities are often caused by the presence of endometrial-like scar tissue outside the uterus.
Pain During Intercourse
Dyspareunia, or painful sex, is a symptom of endometriosis that can cause deep pelvic pain. This pain is due to the inflammation and fibroids in the front wall of the rectum and back wall of the vagina, where most contact during sexual intercourse is focused. The intensity of the pain may vary depending on the location and extent of the endometriosis. The pain can be more intense in some positions than others, depending on exactly where the endometriosis is located and how extensive it is.
Pain with Bowel Movements or Urination
Some people with endometriosis may experience pain or discomfort in the pelvic region during bowel movements or urination. This happens because of the presence of endometrial tissues affecting the adjacent pelvic organs, such as the bladder or intestines. This pain tends to be more severe during menstruation, but each person’s experience is different.
For those living with endometriosis, fertility may be compromised. The endometrial tissue that grows outside the uterus can cause the formation of scarring, adhesion, and structural abnormalities in the reproductive organs. This can interfere with the normal functioning of the ovaries, fallopian tubes, and uterus, making it challenging for the woman to conceive and maintain a pregnancy.
Fatigue, Diarrhea, Constipation, Bloating or Nausea
Endometriosis can cause systemic symptoms, which means that it can affect the entire body beyond the pelvic region. Apart from the pelvic pain and discomfort, women with endometriosis may also experience fatigue and gastrointestinal issues such as bloating, constipation, and diarrhea. In some cases, individuals with endometriosis may also have other associated conditions like irritable bowel syndrome (IBS), autoimmune diseases, and asthma. These symptoms are thought to be caused by the inflammatory response triggered by the presence of endometrial-like tissue in areas outside the uterus.
Chronic Lower Back Pain
Chronic lower back pain is also a common symptom of endometriosis. This pain may radiate from the pelvic region to the lower back, leading to overall discomfort and negatively impacting your daily activities.
Painful Menstrual Cramps
Although over 80% of women experience painful periods6 at some point, those with endometriosis often experience more intense and prolonged cramping during menstruation. These period pains can be severe and may not be alleviated by OTC medications.
Why Does Endometriosis Cause Infertility?
Endometriosis is a complex condition that can impact fertility through various mechanisms7. While it doesn’t necessarily cause infertility, evidence suggests that it can make it difficult for women to conceive. This can occur, for example, if the endometrial tissue implants around the ovaries and fallopian tubes, leading to inflammation and scarring that can block the fallopian tubes8 and make it more difficult for the egg to travel to the uterus and fertilize.
Additionally, endometrial tissue can implant on other organs in the pelvis and outside of it, leading to adenomyosis9. This condition can result in an enlarged uterus, severe menstrual cramps, and heavy bleeding during periods, which can further complicate a woman’s reproductive landscape, potentially impacting fertility outcomes. Adenomyosis is most common10 in women in their 40s and 50s, and those who already have children, but around 20% of cases appear in women under the age of 40.
The inflammation associated with endometriosis11 can further create an environment that may not be conducive to fertility. Inflammation can adversely impact egg quality, sperm function, and motility, and hinder the implantation of the fertilized egg into the uterus.
It’s important to note, however, that age is the single most important factor12 affecting a woman’s fertility and ability to have a healthy baby. Women are born with a limited lifetime supply of eggs that undergo maturation each month once they reach puberty. Unfortunately, women aren’t capable of making new eggs, and in fact, fertility declines rapidly as women hit their mid-30s due to the continued decline in the total number of eggs. This means that while it may increase the risk for infertility, endometriosis is just one of the many factors associated with a woman’s fertility.
Understanding Fertility and Endometriosis: 3 Reasons Not to Panic
If you have been diagnosed with endometriosis and are trying to conceive, it’s normal to feel anxious and concerned. However, it’s also important to remember that many women with this condition are able to conceive naturally and have successful pregnancies and healthy babies.
Even if it may take longer or the journey is a little more difficult than what you might have expected, there’s no need to lose hope or give up on your dream of becoming a mother. Here’s why you don’t need to panic about conceiving with endometriosis:
It Doesn’t Mean You’re Infertile
Can endometriosis affect fertility? Yes, but that doesn’t automatically mean that you won’t be able to have children. With advancements in reproductive medicine and a healthy approach to preconception, many individuals with endometriosis can still achieve their dream of motherhood. Fertility is a complex interplay of hundreds of factors, and there are many successful cases of women with endometriosis who have successfully conceived and given birth to healthy babies.
There are Many Treatment Options
If you’ve been diagnosed with endometriosis and are trying to conceive, there are many treatment options available13, including:
- Medical management to improve hormonal balance and induce ovulation
- Surgical interventions to remove endometrial implants and adhesions
- Assisted reproductive technology (ART) procedures, such as in vitro fertilization (IVF) and intrauterine insemination (IUI)
You Don’t Have to Stop Trying
Endometriosis may introduce some obstacles, but it doesn’t mean you need to abandon your dreams of starting a family. Many women with endometriosis conceive naturally and others do it with the help of medical interventions. Each fertility journey is unique and some may require extra time and patience. Seeking guidance from reproductive specialists, taking care of your physical and mental health, and exploring your fertility options can empower you to continue pursuing your goal of parenthood.
Boost Your Fertility with FertilitySmart
Navigating the complexities of fertility and endometriosis can be an emotionally charged journey. At FertilitySmart, we understand the difficulties that come with a diagnosis of endometriosis and the impact it can have on your dreams of motherhood. However, it’s important to remember that an endometriosis diagnosis is not an infertility sentence, and there are ways to increase your chances of achieving the family you’ve always dreamt of.
We believe in a holistic approach to fertility management that includes adopting a healthy lifestyle, seeking expert help when needed, and prioritizing your physical and emotional health no matter what. Our award-winning, all-natural fertility support supplements for women are designed to support reproductive health and optimize your chances of conceiving. Additionally, we offer male fertility supplements that provide essential nutrients for proper hormone metabolism, sperm formation, and motility.
Everyone’s pregnancy journey is unique, and there’s no one-size-fits-all solution. Education, self-compassion, and a positive mindset are powerful allies as you navigate fertility and endometriosis. The FertilitySmart family is here to support you every step of the way and help you achieve your fertility goals. Contact us to learn more!
1 Alimi, Y., Iwanaga, J., Loukas, M., & Tubbs, R. S. (2018). The Clinical Anatomy of Endometriosis: A Review. Cureus, 10(9), e3361. https://doi.org/10.7759/cureus.3361
2 World Health Organization. (2023, March 24). Endometriosis. World Health Organization; World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis
3 Endometriosis and its impact on fertility. Massachusetts General Hospital. (n.d.). https://www.massgeneral.org/obgyn/fertility/news/endometriosis-and-its-impact-on-fertility
4 Endometriosis, fertility and pregnancy. Endometriosis UK. (n.d.). https://www.endometriosis-uk.org/endometriosis-fertility-and-pregnancy#:~:text=It%20is%20estimated%20that%2060,disease%20distorts%20the%20reproductive%20organs.
5 Endometriosis. Fertility Reproductive Medicine Center. (n.d.). https://fertility.wustl.edu/learn/infertility-factors/endometriosis/
6 Grandi, G., Ferrari, S., Xholli, A., Cannoletta, M., Palma, F., Romani, C., Volpe, A., & Cagnacci, A. (2012). Prevalence of menstrual pain in young women: What is dysmenorrhea?. Journal of pain research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392715/
7 Macer, M. L., & Taylor, H. S. (2012, December). Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and gynecology clinics of North America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/
8 Hill, C. J., Fakhreldin, M., Maclean, A., Dobson, L., Nancarrow, L., Bradfield, A., Choi, F., Daley, D., Tempest, N., & Hapangama, D. K. (2020, June 18). Endometriosis and the fallopian tubes: Theories of origin and clinical implications. Journal of clinical medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355596/
9 Adenomyosis. Johns Hopkins Medicine. (2022, June 30). https://www.hopkinsmedicine.org/health/conditions-and-diseases/adenomyosis
10 Harada, T., Khine, Y. M., Kaponis, A., Nikellis, T., Decavalas, G., & Taniguchi, F. (2016, September). The impact of adenomyosis on women’s fertility. Obstetrical & gynecological survey. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049976/
11 Mohammed Rasheed, H. A., & Hamid, P. (2020, November 16). Inflammation to infertility: Panoramic view on endometriosis. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746006/
12 Health, D. of. (2014, March 3). Age and fertility. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility#
13 Treatment options for endometriosis - informedhealth.org - NCBI bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK279498/