Pregnancy Chances and Risks After Endometrial Ablation

OB/GYN explaining endometrial ablation to patient

While it is still possible to get pregnant after an endometrial ablation, there is an increased risk of complications from the start of your pregnancy until after delivery, including death. Endometrial ablations are not good options for women who have not yet decided to stop having babies.

Effect of Procedure on Pregnancy

Pregnancy after an endometrial ablation is a problem of implantation, not a problem of ovulation or fertilization.

Implantation

After an endometrial ablation you can still get pregnant because your ovaries continue to function normally. An early embryo has a decreased chance of implanting in the uterus after an endometrial ablation because the procedure destroys (ablates) the endometrium, the inner lining of the uterus.

After the ablation, the lining is absent, or too thin or scarred to respond normally to your ovarian hormones, estrogen and progesterone, that prepares it for a pregnancy. If the embryo manages to implant, the implantation is likely to be abnormal and this leads to problems with the pregnancy.

Chance of Pregnancy After Ablation

The chance that the embryo will implant is low, but possible. According to a review article in the French Journal of Gynecology Obstetrics and Biology of Reproduction the chance of pregnancy (implantation) after endometrial ablation is between 0.7 and 2.4%.

Pregnancy Risks

Do not try to get pregnant after an endometrial ablation. Though the chance of pregnancy implantation is low, you have a chance of significant risks and complications if you conceive and the embryo succeeds in implanting in your uterus.

Complications

A review of the risks of complications of pregnancy after endometrial ablation in the French Journal article cited previously shows the following:

  • Abnormal uterine bleeding early or later in the pregnancy
  • A chemical pregnancy
  • Abnormal attachment of the placenta which can cause a difficult pregnancy and delivery and increased risks for the baby throughout your pregnancy
  • Early miscarriage because of abnormal placental attachment
  • Second trimester pregnancy loss
  • Premature delivery because of abnormal placental attachment or intra uterine growth retardation
  • Your baby dying during labor and delivery or soon after birth (perinatal mortality)
  • Cesarean section because of problems with you or your baby
  • The placenta fails to separate after the baby is born (retained placenta) and you can have severe bleeding
  • Emergency hysterectomy because of severe, uncontrollable bleeding at or after delivery

The most serious complications of abnormal implantation include severe hemorrhage from your uterus and death.

Because of these risks, if you want to get pregnant in the future you should not have an endometrial ablation. This is an important point to discuss with your own doctor.

In Case of Pregnancy

If you get pregnant after an endometrial ablation, consider this a high risk pregnancy and:

  • Be on the alert for early warning signs of pregnancy such as irregular vaginal bleeding or pelvic pain.
  • See your doctor for an early - and repeat - blood pregnancy tests to see how well the embryo is growing.
  • Keep all your doctors and testing appointments to follow your pregnancy closely.
  • If you miscarry or deliver at home, call your doctor or go to the hospital quickly because of the risk of heavy bleeding and retained placenta.

Bleeding complications can happen during labor and delivery and after the baby is born.

The Endometrial Ablation Procedure

The endometrial ablation procedure destroys or thins the endometrium lining of the uterus by use of various techniques:

  • Apply heat to the lining by:
    • Electric current which generates heat to destroy the lining (electrocautery)
    • Pumping heated fluid into the uterine cavity (hydrothermal therapy)
    • Heated solution in a balloon inserted into the cavity (balloon therapy)
  • Freezing by using a cold probe (cryotherapy)
  • Electrical frequency through a device which generates electrical current (radiofrequency)
  • Use of microwave energy (microwave therapy)

The ablation is usually done while looking in the uterine cavity, either by hysteroscopy or by ultrasound guidance. The procedure is safe and can be done in your doctor's office or in the operating room.

Indications for the Procedure

Endometrial ablation treats recurrent heavy bleeding or prolonged bleeding from the endometrium (menorrhagia). The procedure is usually suggested after nonsurgical methods, such as hormone treatment failing to decrease or stop the abnormal bleeding.

Evaluation and Decision

Before any treatment of abnormal uterine bleeding you will have a complete evaluation to rule out cancer, infection, or any other problems in your uterus that might be the cause of the bleeding.

After evaluation if non-surgical treatments do not help your doctor might suggest an endometrial ablation if you have:

  • Recurrent episodes of excessive bleeding including days of changing a pad or more an hour
  • Episodes of prolonged bleeding lasting more than 10 days
  • Your anemia won't respond to treatment because of the amount of bleeding
  • A medical problem which prevents you from taking hormones or other medicines to treat the bleeding

You are a good candidate for endometrial ablation if you:

  • Are otherwise healthy
  • Can't get pregnant
  • Don't want to get pregnant
  • Have completed childbearing and will elect to have a sterilization at the time of endometrial ablation
  • Are near menopause (perimenopausal) and you are likely to be menopausal in a few months to a year

The procedure can delay or prevent a more complicated surgery such as a hysterectomy.

Birth Control Considerations

Uterine ablation and pregnancy do not mix well. If you don't want to get pregnant, or you have completed your childbearing, you should strongly consider sterilization at the time of endometrial ablation. If sterilization is not an option, choose an effective form of birth control such as a hormonal IUD or other hormonal contraception.

Consider Pregnancy Aspects and Risks

Because of the possible risks and complications from pregnancy after endometrial ablation, don't try to get pregnant after the procedure. If you want to be pregnant in the future you should not have an endometrial ablation. Be sure to discuss all pregnancy aspects with your doctor, including options for birth control, before you have the procedure.

Pregnancy Chances and Risks After Endometrial Ablation