How Endometriosis Can Affect Fertility

Happy man listening to his pregnant wife's belly

Many women who have endometriosis may be wondering about the link between endometriosis and fertility.


Endometriosis is the growth of uterus tissue, call endometrium, in places other than the uterus. Most often, this tissue is found on the ovaries, bladder, and bowels. Each month during the women's period, the endometrium is shed in these other locations, just like what occurs inside the uterus. With no way for this shedding to leave the body, however, the tissue builds up. This causes scar tissue, inflammation, and pain.

Although there is no known cause for endometriosis, some doctors believe the endometrial lining backs up out of the uterus and grows in other areas. Other possible causes include genetics, an immune system disorder, and previous surgeries that introduce the endometrial lining into other areas.

Endometriosis occurs in about 10 percent of all women during childbearing years, making it a common, but painful, problem. Heavy cramps are the most common sign for women with endometriosis, but many women also experience pain during sex, heavy periods and spotting, and difficult bowel movements. For some women, having difficulty trying to conceive may indicate a relationship between their endometriosis and fertility.

Endometriosis can sometimes be diagnosed with an ultrasound if the growths are large enough to be seen. Most commonly, diagnosis is discovered with a laparoscopy. This is a minimally invasive outpatient procedure where two small incisions are made in the abdomen and the doctor is able to look at the uterine cavity with a small light.

Treating Endometriosis

There are several treatment options that can reduce the symptoms of endometriosis, though there is no way to cure the condition. Only menopause or a hysterectomy will stop the growth altogether.

  • Birth control pills: The pill can lessen the likelihood of cramping by preventing the growth of endometrial tissue. This causes less cramping, but can only be used by women who are not actively trying to conceive.
  • Pain medication: Ibuprofen and prescription pain medicines can reduce the pain, but do not treat the endometriosis. For some women, the side effects of medication, like drowsiness, is better than the pain they have each month.
  • Other hormone treatments: Using the hormones gonadotropin or progesterone can both reduce the growth of endometriosis. They have several side effects, like hot flashes, weight gain, and osteoporosis, that may deter some women from using them.
  • Surgery: Endometrial tissue can be reduced through a laparoscopy, but it is often a temporary solution since the tissue can grow back. If a woman does not want to have children or is finished with childbearing, she may opt for a hysterectomy. By removing the uterus and stopping periods, the endometriosis will also stop. This is considered a last resort for many women and their doctors.

The Link Between Endometriosis and Fertility

Some women who have endometriosis might not have any trouble conceiving. This is because the endometrial growths can appear on the bowels, bladder, or in the abdomen, areas that don't have any effect on fertility. Even in cases where the growths occur on the outside of the uterus or fallopian tubes, fertility might not be impacted.

Endometriosis and fertility have a definite link in cases where the fallopian tubes are blocked or damaged by the growths or the ovaries are affected. If the ovaries are unable to produce viable eggs that can travel freely down the fallopian tubes, achieving pregnancy will be much more difficult.

There are several fertility options available to women who have trouble with endometriosis and fertility. IVF and intrauterine insemination are both likely options that a fertility clinic will recommend. For some women, taking a fertility medication like Clomid is all the help they'll need to conceive.

For some women, a laparoscopy may increases their chances of conceiving if the doctor is able to remove the growths that are potentially affecting fertility. While some studies show a significant increase in pregnancy among women who have this procedure, it is not without risks that could further damage fertility.

Many factors need to be considered when treating endometriosis and fertility, including how long the woman has been trying to conceive, her age, general health, and the severity of the endometriosis. Many fertility clinics will opt to start fertility treatment with medications before trying more aggressive means of assisted reproduction.

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How Endometriosis Can Affect Fertility