Can You Get Pregnant with Endometriosis?

UPDATED ON 02ND MAY. 2025

Overview of Endometriosis

The uterus in the pelvis of the female body consists of a lining, called the endometrium lining, which thickens over the menstrual cycle and finally breaks down and sheds blood that passes through the vagina. 

Sometimes, the endometrium tissue grows outside the uterine lining. This tissue has the same characteristics as the endometrium, which means it will grow, break down, and bleed.

Normally the blood is passed through the vagina, but since the endometrium-like tissue is formed outside the uterus, it can get “trapped” inside the body, and under the hormonal and endocrinological influence, this may start developing into an ectopic endometrium.

This condition is called endometriosis. It can range from minimal to severe, ascending through four stages. It can cause extreme menstrual pain along with heavy or irregular periods.

Minimal and mild stages have minor lesions, but moderate and severe cases can have cysts in either or both ovaries, and along with this, they can also have the presence of deep endometriotic nodules. These endometriotic nodules grossly distort the anatomy and also are a major cause of infertility, along with causing excessive pain.

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How does it affect pregnancy?

Studies have shown that women with severe endometriosis can have difficulty getting pregnant. 

In the case of mild and minimal stages, conceiving might not be very difficult, but considering the location of the disorder, there is a possibility of anatomical changes causing infertility. It has been found that around 70% of women with minimal to moderate stages of endometriosis didn’t have any problem getting pregnant. 

However, one has to categorically understand the fact that even minimal and mild endometriosis can cause a distortion of the anatomy of the fallopian tubes, as well as increased contractility in the uterus.

Now, as a result of this, despite other parameters being grossly normal, surgical management of the disease in order to restore the anatomy becomes extremely important, and only then can the majority of these patients expect a natural conception.

Normally, to get pregnant, the sperm must meet the egg and unite to form a zygote. With women having severe cases of endometriosis, cysts may be formed around the fallopian tube, preventing the egg from uniting with the sperm.

Otherwise, too, the disorder may directly damage the egg or the sperm. Even though it is not definite that endometriosis will cause infertility, studies have shown that infertility can raise the risk of getting endometriosis by 6-8 times. 

While it has been seen that there are very rare cases of complications caused by endometriosis during pregnancy, there is an increased risk of placenta previa or low-lying placenta.

Chances of Natural Pregnancy with Endometriosis

Women with endometriosis with minimal to moderate cases can conceive naturally.

Although in some women, that may be the problem, hence there are several ways through which you can boost your chances of getting pregnant:

– Make sure that if, in case you are having chronic pelvic pain or painful menstruation, you see an endometriosis specialist, Dr. Jay Mehta. This will allow the doctor to have a thorough evaluation of your pelvis and also a fertility evaluation simultaneously and judge the severity of your disease based on ultrasound as well as clinical examination findings.

– Then your doctor will make a plan if the patient can be allowed to conceive naturally by keeping in mind the condition of the fallopian tubes and assessing the parameters of your male partner as well.

–  The majority of the patients may end up with a corrective surgery if the size of the endometriotic cyst, which is present in the ovary, is more than 4 cm.

– The presence of any form of endometriotic node will warrant the patient to undergo surgery in order to make sure that the anatomy is restored and the pain associated with endometriosis goes away.

Remember, in the presence of endometriosis, patients may also experience extremely painful intercourse, which is called dyspareunia, and this pain can be greatly relieved at the end of the surgery, allowing patients to have smooth intercourse to achieve a natural conception.

– Most of the patients who are planning to attempt a natural conception along with endometriosis may also experience a condition called LUF, which is luteinized unruptured follicles. This condition usually requires surgical management.

– Many of the patients who have undergone surgery have not been operated on by an expert. They may usually encounter a severe loss in fertility at the end of the surgery, which causes a drastic reduction in the AMH levels. As a result of this, many of these patients may eventually end up with assisted reproduction in the form of in vitro fertilization (IVF).

– In many of the situations, your doctor may advise you to go ahead with fertility first rather than undergoing surgery. However, this decision is based on the evaluation of the pain parameters of the patient.

Unfortunately, in a country like India, we’re very limited in the specialization available to treat the disease of endometriosis. The majority of the patients end up visiting doctors who are not trained in the management of the disease, and as a result of this, the majority of them end up with an unindicated IVF. Which ultimately results in a failure of the treatment. This causes the patient to go through a severe amount of financial, emotional, and physical, as well as mental, trauma.

As a result of this, patients who are planning for conception and have been diagnosed with endometriosis are strongly advised to meet an endometriosis specialist who also specializes in fertility management so that the patient gets the most optimal outcomes for this disease.

As a referral unit for endometriosis across our country, we have noticed that the majority of the women, after undergoing the surgeries, even for deep endometriosis and excision of the nodules, with careful management of fertility, have bilateral patent fallopian tubes, and this allows these patients to plan for conception within 3 to 6 months of the surgery, and the majority of them usually end up conceiving within the first year of getting operated on.

Can it Cause Miscarriage?

While there is no proper evidence to show the effects of endometriosis on miscarriage. However, two databases from Sweden and Scotland may suggest that there is a link between endometriosis and miscarriage. The study in Sweden found that 20% of women are more likely to have a miscarriage if they have endometriosis.

Almost similar results were found in Scotland. With that being said, women who went through the keyhole surgery did not show any benefit over a miscarriage.

Conclusion

Endometriosis is a painful disorder, and this is going to require an extremely good specialised team approach in order to manage every individual case. Women must also consider pain symptoms as well as the desire to become pregnant prior to taking the decision for getting a surgical management done for this disease.

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Endometriosis

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