The biggest fear most women with Endometriosis have is whether they will be able to have a baby. This blog details the risks, how endometriosis affects fertility and how to increase your chances of having a baby.

Many women with endometriosis will become pregnant normally. Others will be able to conceive normally after surgery to remove the endometriosis. Some women may require IVF as well as expert surgery to become pregnant. Some sadly are unable to have a baby at all (1).

Around 3 to 4 in every 10 women with endometriosis have difficulty becoming pregnant. Most women with endometriosis are not infertile. The more severe the endometriosis is, the more likely it is that there will be fertility problems (1).

“Around 3 to 4 in every 10 women with endometriosis have difficulty becoming pregnant. Most women with endometriosis are not infertile.”

How does endometriosis affect fertility?

No one really know how endometriosis affects fertility but there are several theories.

Severe endometriosis causes scarring and pelvic organ distortion which may affect the ability of the egg to move from the ovary to the uterus (via the fallopian tubes) (1).
The lining of the uterus (endometrium) functions differently in women with endometriosis. This may prevent the successful implantation of the embryo in the uterus (1).
Endometriosis may affect the egg itself (1).
If sex is painful it, sex might not happen as often, so obviously reducing the chances of conception.

What else can affect fertility besides endometriosis?

Women very often put the blame on themselves for their fertility issues but it takes two to tango!

There are several factors that determine why you may not become pregnant:

The quality of the man’s sperm.
The woman’s age.
Whether you ovulate each month.
Whether the fallopian tubes are open.
Stress (of work, of not getting pregnant etc).
Endometriosis.

Alone these may not stop a pregnancy but in combination pregnancy becomes less likely.

Can I improve my fertility?

Yes! As for every woman the chances of conception success (+/- IVF) and a healthy baby are improved by:

A healthy BMI (18-24).
Exercising regularly.
Prenatal and pregnancy vitamins at the time of conception and during pregnancy.
Healthy diet.
Stopping smoking and illegal drug use.
Staying away from chemicals such as pesticides, plastics, phthalates, solvents, or products with fragrance added (1).
Your partner can also increase his fertility with the points above as well as wearing loose fitting underwear and avoiding saunas etc which increase the temperature of the testicles.

“Surgery to remove endometrioma of the ovary may decrease fertility further by decreasing your ovarian function.”

Can I improve my fertility by treating endometriosis?

Yes and no.

Getting surgery to remove endometriosis around the pelvis (peritoneum) may be helpful (1).
However surgery to remove endometrioma of the ovary may decrease fertility further by decreasing your ovarian function. You should consider getting a second opinion from a fertility expert and make sure your surgeon is very experienced at endometriosis surgery. It can be hard to see and distinguish (1).
Medications for endometriosis do not improve your fertility and in fact decrease your chances because you can’t be using them whilst trying for pregnancy (1).
If sex is painful, pelvic floor physiotherapy from a Women’s health physiotherapist can be really helpful to release the tight pelvic floor muscles as well as desensitise the vagina. Therefore this will increase your desire to have sex to hopefully conceive.

“A women’s health physiotherapist can be really helpful to release the tight pelvic floor muscles as well as desensitise the vagina. Therefore this will increase your desire to have sex to hopefully conceive.”

What else can I do?

Fertility clinics will be able to assist you with the best plan for you and your partner.
Gynaecologists specialising in endometriosis will be able to give you the best treatment for your endometriosis and expert advice on how to best manage your endometriosis and increase your chances of conception.
Talk to your partner about what worries you about struggling to have a baby/ not having a baby then work out how to manage your concerns
Try to be positive and work on your relationship as a couple. Do something fun and romantic together, go out to dinner, try a dance class?!
Talking to a Councillor/ psychologist with or without your partner about your potential sadness and stress of struggling with conception or working through the realisation you will not be able to have a baby is very important for your mental and relationship health.
Working on your stress levels can help with conception success. Meditation, purposeful deep breathing, yoga, bush walks, talking about your concerns, can all help.
If all your conception efforts have been unfruitful consider adoption and fostering.

“Working on your stress levels can help with conception success. Meditation, purposeful deep breathing, yoga, bush walks, talking about your concerns, can all help.”

Will endometriosis hurt my baby?

No. The chance of your baby being born early or being smaller than average is slightly higher but this is the only risk (1).

Recognising endometriosis in your daughter

If you manage to have a baby girl, hopefully they will not be afflicted by endometriosis but:

Endometriosis can start as a teenager.
Signs can be her needing sick leave/ the sick room because of period pain.
Seek diagnosis from a gynaecologist.
Realising your daughter has endometriosis in her teens and getting treatment for it will increase her chances of having a baby too.

Summary

Endometriosis can affect your chances of having a baby but most women with endometriosis can.
There are several things you can do to increase your chances of conception that applies to everyone.
Endometriosis treatments may increase or decrease your chances of conception.
Prioritise your relationship and talk to each other about your concerns and get counselling alone or together to decrease your stress levels which may also affect conception.

Reference

Evans, S (2010) Endometriosis and pelvic pain. Adelaide. Dr Susan F Evans Pty Ltd.

Melli Tilbrook is a Physiotherapist practicing at Adelaide Physiotherapy and Pilates Studio, Beulah Park

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Endometriosis and chances of having a baby