If you want to get pregnant and you’re diagnosed with endometriosis, you might assume that all hope is lost. Unfortunately, the common misconception that endometriosis and infertility go hand-in-hand has caused lots of women untold amounts of stress.
But fortunately, there is plenty of good news about endometriosis and fertility, explains Divya Kelath Shah, MD, MME, a Penn Medicine physician and assistant professor of clinical obstetrics and gynecology. With the right treatment, you might get pregnant more easily than you think.
Three Reasons Not to Panic About Endometriosis
Below are three reasons why Dr. Shah says hopeful moms-to-be shouldn’t panic about endometriosis.
Just because you have endometriosis doesn’t mean you’re infertile
Endometriosis happens when the cells lining the uterus start to grow in places they shouldn’t, such as the ovaries or fallopian tubes. These growths can cause problems like blocking your fallopian tubes (the tubes where egg cells travel to the uterus), or forming scar tissue that makes it harder to get pregnant.
But the problem varies for each woman. Some people might have extensive endometriosis; others might have just a few “spots” where the growths occur.
“Endometriosis can prevent a woman from getting pregnant, but it certainly doesn’t have to,” Dr. Shah says.
She says it is true that a greater proportion of women with endometriosis have difficulty getting pregnant. “But just because you have endometriosis, that doesn’t automatically mean you have infertility,” she says.
There's no harm in trying to get pregnant on your own when you have endometriosis
If you have been diagnosed with endometriosis, don’t assume you need to see a fertility specialist right away when you want to get pregnant. “I would never tell someone not to try to get pregnant on her own,” says Dr. Shah. “Many women are very successful with that approach.”
“However, if a woman with endometriosis is not pregnant after six or seven months of trying on her own, we may ask her to come in for an infertility consult to see if the endometriosis is contributing to her difficulty getting pregnant,” she adds. “This is in contrast to the one-year timeframe that we would advise a typical low-risk woman to try before seeking fertility assistance.”
There are many treatments, depending on what's right for you
“If you have endometriosis and are struggling with fertility, the first step is to be evaluated by a fertility specialist to see if the fallopian tubes are open or not,” Dr. Shah explains.
This is because there are two main ways that endometriosis can impact a woman’s fertility. Dr. Shah refers to these issues as macroscopic and microscopic disease.
“Some women with macroscopic disease may have lesions and scar tissue that can sometimes block the fallopian tubes,” she says. “This can make it difficult for the egg to make its way into the uterus.”
On the other hand, many women with endometriosis have completely open tubes—but still struggle with fertility. This is “microscopic endometriosis,” and the reasons for the difficulty with fertility are less well understood. “There are many theories, but no one knows for sure,” Dr. Shah says.
An evaluation with a fertility specialist can help physicians determine the extent to which your endometriosis is contributing to infertility and guide treatment accordingly. Depending on the extent of disease, treatment options for infertility might range from oral medications all the way up to more advanced treatments like in vitro fertilization, Dr. Shah explains.
The spectrum of options depends on many factors, including your age, reproductive history, overall health, and the results of your infertility evaluation, Dr. Shah adds. In the end, physicians will do everything they can to tailor your treatment to your individual needs.
“We have come quite a long way in understanding endometriosis, how it affects fertility, and how to treat it,” Dr. Shah says. “Your chances of conceiving are better than they’ve ever been, so it’s worth looking into the many treatment options that are available.”