Endometriosis, defined as the growth of endometrial tissue in abnormal locations such as the ovaries or within the peritoneal cavity, can be a painful thing to deal with, especially when it comes to endometriosis and pregnancy. Not only can it cause conception problems, it is often difficult to handle.
Endometriosis, or endo, is a condition that afflicts women of childbearing age. Several theories are being explored as to why women get the condition, but no specific answer has been found. Possible risk factors include having an immediate female blood relative with the condition, never giving birth, and having long periods with short cycle lengths. Preventing the disorder is impossible as definite causes have yet to be identified.
Symptoms, when present, include long and painful periods, back pain during periods, diarrhea/constipation during menstruation, pain in the lower abdomen, and pain during intercourse. Ovary pain is another sign of endometriosis. These symptoms can overlap with other health problems, so doctors will do testing to determine whether or not endo is the cause of the symptoms.
The formation of lesions, cysts, and adhesions outside of the uterus causes the pain felt by women with endometriosis. Women who think they may have endometriosis can fill out a questionnaire provided by the Endometriosis Research Center and bring it to their doctor. If their doctor agrees the symptoms fall in line with endometriosis, s/he will order further exams and testing. Doctors will do pelvic exams, ultrasounds, or laparoscopic surgery to determine the diagnosis.
Treatment for endometriosis often involves painkillers or hormonal treatments, like birth control pills. In some cases, surgery and/or hysterectomies are performed upon women with severe endometriosis. Menopause often ends symptoms for most women.
Endometriosis and Pregnancy Problems
Not every woman with endometriosis experiences symptoms. In fact, some women do not realize they have endometriosis until they have problems getting pregnant. Endometriosis can affect fertility and even can be a factor in causes of secondary infertility. Couples who have testing done may find out that endometriosis is the reason for infertility. According to the National Institute of Child Health and Human Development (NICHD), endometriosis is the explanation for infertility in 25 to 50 percent of couples. According to the NICHD, this may be due to one of these three reasons:
- Endometriosis can somehow alter the uterus, making it unable to support an embryo or pregnancy.
- Endometriosis may "change" a woman's eggs.
- Endometriosis may block the release of eggs or fertilized eggs from implanting in the uterus.
Getting Pregnant With Endometriosis
The Mayo Clinic notes that some doctors advise couples who want children to begin trying to conceive as soon as possible because with time, the condition can deteriorate. Other physicians may want couples to try conceiving without intervention for six months to a year before more drastic measures are taken.
Women who have undergone surgery to treat endometriosis have different outlooks as far as pregnancy is concerned, depending on the severity of their condition. Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health, consider pregnancy chances in relation to the severity of endo to be approximately:
- Mild: 75 percent
- Moderate: 50 to 60 percent
- Severe: 30 to 40 percent
Women with moderate to severe endometriosis or who have been trying to get pregnant for several months unsuccessfully may need to undergo infertility treatments. With the average time to conceive ranging for fertile couples, only a doctor can determine when couples who have endometriosis as an underlying fertility problem should begin looking into IVF.
IVF, or in vitro fertilization, is when the sperm and egg are combined outside of the body and then placed back into the uterus. This procedure, while often effective, is not a guarantee of pregnancy. It involves a lot of dedication by both partners, as drugs must be administered prior to harvesting eggs and the procedure is tremendously expensive if not covered by insurance. Additionally, the risk for multiple births goes up.
Endometriosis During Pregnancy
The Merck Manual notes that if a woman does become pregnant, for some, the condition may go into remission temporarily. After the baby is born, some women may still have endometriosis but not have conception problems or symptoms.
Doctors have noted that breastfeeding can also help alleviate symptoms for some women. However, the idea that pregnancy is a "cure" for endometriosis is generally considered false.
On the other hand, Endometriosis.org, a global endometriosis organization, notes that as the uterus stretches during pregnancy, prior adhesions may stretch and cause pain. Higher levels of estrogen can also cause more severe endometriosis symptoms for some pregnant women.
The medical community appears divided about whether or not endometriosis can lead to miscarriage during pregnancy. As of 2006, there appears to be insufficient evidence linking endometriosis and (recurrent) miscarriage.
As of 2008, a potential complication has been observed for women who achieved pregnancy through assisted reproductive techniques who have had endometriosis surgery. The medical community has noted at least two cases of spontaneous hemoperitoneum in the third trimester. Hemoperitoneum is blood in the peritoneal cavity. Studies are needed in order to determine an actual link between the two.
The relationship of endometriosis and pregnancy is unpleasant and distressing. While it has not been proven to cause life-threatening pregnancy related problems in and of itself, endometriosis does make actual conception more difficult for a number of couples.