Laura Berlinsky-Schine
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If you have endometriosis, you may already know it. You could experience symptoms like abdominal and pelvic pain that increases during menstrual periods; irregular or heavy menstrual periods; severe cramping; constipation or diarrhea; painful or frequent urination; fatigue; and pain during intercourse. Some women, however, have no endometriosis symptoms, and infertility is the first indication of the disease.

Many women with endometriosis have no trouble getting pregnant. However, roughly one third of women with the disease do. Read on to learn about how endometriosis can affect a woman’s chances of getting pregnant and her pregnancy itself.

What is endometriosis?

If you have endometriosis, cells that normally line the walls of your uterus (endometrium) grow outside the uterus, forming endometrial lesions. Most commonly, these endometrial cells affect the ovaries, fallopian tubes, bowel, and pelvic tissue lining, but they may also affect others areas inside the body, such as the vagina, cervix, or bladder.

The tissue breaks down and bleeds much like the endometrial tissue that is shed during menstruation does, but since it has nowhere to go, it may irritate the tissue of the organs it affects, and sometimes develop scar tissue and adhesions in these areas.

How is endometriosis diagnosed?

Your doctor may ask you questions about any pain symptoms associated with the disease. She may also perform a pelvic exam, checking for abnormalities including cysts and scars. An ultrasound may allow her to better view your reproductive organs.

Laparoscopic surgery is the only definitive way of diagnosing endometriosis, and the procedure is generally only used as a last resort if medical management of pain symptoms does not yield improvement. If you suffer from infertility, this will often be an initial treatment option.

Why do women with endometriosis have a greater risk for infertility?

Just as there is no definitive explanation as to why some women have the disease, we have yet to fully understand why women with endometriosis are at a greater risk for infertility than those without the disease. Possible explanations include scarring of or damage to the fallopian tubes and ovaries, egg damage, fallopian tube blockage, or ovaries containing endometriosis cysts adhering to the uterus, bowel, or pelvic side wall.

How will endometriosis affect my pregnancy?

The good news is that many women report diminished endometriosis symptoms during pregnancy. This is likely because the high levels of progesterone a woman experiences while pregnant give her some relief from the pain caused by endometriosis. Unfortunately, your symptoms may return after you give birth, and you may have trouble getting pregnant again. Some women report that breastfeeding helps alleviate pain as well. Keep in mind that you won’t be able to use other treatments like birth control and other hormones for pain symptoms while you’re pregnant.

There is some speculation that women who have endometriosis may be at a greater risk for preterm birth, but this risk has not been established. Other concerns include elevated blood pressure and bleeding or spotting during the pregnancy.

According to two recent studies, women who have endometriosis also have an increased of miscarriage.

However, many women with endometriosis have normal pregnancies and deliver healthy babies.

What if I can’t get pregnant?

Endometriosis is the leading cause of female infertility, a diagnosis given to couples who have been unable to conceive despite attempt for one year. Fortunately, you may still be able to conceive with treatment.

Treatment varies based on the individual cases. In most cases, laparoscopic surgery is an initial step. In the laparoscopy, a thin, lighted telescope is inserted through a small incision in the belly button to look into the pelvis. During the procedure, endometriotic cysts, adhesions, and implants are removed. While this minimally invasive surgical procedure may reduce pain symptoms in some women, there is little evidence that it substantially improves fertility rates in women suffering from endometriosis, although it may improve the chances of pregnancy to some extent.

Another course of treatment, which may be used if surgery is unsuccessful, is controlled ovarian hyperstimulation (COH), the use of fertility medications to induce ovulation in women, combined with intrauterine insemination (IUI), otherwise known as artificial insemination. This treatment may improve fertility rates among women with mild to moderate endometriosis, but is less successful in women with severe endometriosis.

Women with severe endometriosis, particularly those with substantial pelvic distortions, who have trouble getting pregnant after attempting these courses of treatment may consider in vitro fertilization (IVF). This course of treatment for infertility generally has the highest success rate. The prognosis for women with endometriosis who undergo IVF treatments is comparable to that of women without endometriosis who undergo IVF. Pregnancy rates are generally higher for women under the age of 35 and lower for those over the age of 40.

There is no cure for endometriosis, nor is there any real evidence of being able to lessen your chances of having the disease. (There are ways to lessen the symptoms and side effects of endometriosis through medical interventions, diet, and home remedies.) However, it’s important to remember that having endometriosis doesn’t mean you necessarily can’t get pregnant. Many women with the disease have no trouble conceiving at all. If you do have trouble getting pregnant, and you think you might or know you have endometriosis, be sure to discuss your options and courses of treatment with your doctor. There are likely several options available to you. There are also many options for treatment for endometriosis symptoms associated with pain, including oral contraceptives (birth control pills) and anti-inflammatory drugs, so be sure to discuss other treatment options if your symptoms of endometriosis are affecting your health in other ways.