Endometriosis is often associated with, or causes, infertility. It has been estimated that 20-50% of women with infertility are diagnosed with endometriosis, and 30-50% of women with endometriosis experience infertility.1-3 Infertility is the inability to become pregnant or carry a baby to term, however, endometriosis does not always cause complete infertility. In some cases, endometriosis may decrease a woman’s chances of becoming pregnant, however, pregnancy is still possible (subfertility). In other cases, a woman’s fertility may not be affected at all.
In addition to having an association with infertility, research suggests that women with endometriosis may also have a higher risk of developing pregnancy-related complications. These complications include, but are not limited to, delivering preterm, undergoing a caesarean section (C-section), experiencing pre-eclampsia (high blood pressure and protein in the urine that develops later in pregnancy), placental complications, miscarriage, ectopic pregnancy, uterine rupture, bowel perforation, and bleeding during pregnancy or after birth.2-7
How does endometriosis cause infertility?
For some women whose fertility is impacted by their endometriosis, the cause may be obvious, such as scarring that blocks the fallopian tubes or that has impacted the structure of key reproductive organs. In other cases though, the cause of infertility may not be obvious. Some common theories on how endometriosis might impact fertility include, but are not limited to:
Scarring and distortion of anatomy
Issues with the immune system or proper immune system functioning
Congenital anomalies (present at birth), such as müllerian anomalies or developmental irregularities within the reproductive system8-10
It’s also possible that the cause of a woman or couple’s infertility is not related to endometriosis at all. Other common causes of infertility include abnormal sperm production or function, exposure to toxins such as cigarette smoke, issues with sperm delivery, ovulation disorders, uterine fibroids, early menopause, and other underlying health conditions. In some cases, there is no apparent cause of infertility. Your healthcare provider will help you determine what is happening in your specific situation (if possible), and recommend treatment options, if desired.11
Treatment strategies for individuals who desire pregnancy
There are several potential treatment options for women experiencing infertility or reduced fertility. The most appropriate treatment for a woman experiencing these issues will be dependent on a variety of factors, including her age, personal preferences, financial situation, and underlying cause of infertility or reduced fertility. Some of these potential treatment options for women include:
Lifestyle changes: In some cases, lifestyle changes, such as quitting smoking, losing weight, reducing alcohol intake, avoiding drugs, and limiting caffeine, among other changes, may help increase a woman or couple’s chances of becoming pregnant.
Fertility medications: Fertility medications are typically intended for use by women who have an ovulation-related issue. These drugs are used to stimulate the hormones responsible for initiating ovulation or block hormones that are preventing ovulation. Some of these medications include clomiphene (Clomid), letrozole (Femara), gonadotropins (Repronex, Menopur, Gonal-F, Follistim, Bravelle, Ovidrel, Pregnyl, Novarel), metformin (Glucophage), and bromocriptine (Cycloset).
Surgery: Surgical interventions for infertility often focus on correcting developmental abnormalities or unblocking clogged fallopian tubes.
Intrauterine insemination (IUI): A procedure in which sperm are delivered into the uterus via a catheter to increase the chances of sperm cells meeting the ovulated egg.
Assisted reproductive technology: An example of an assisted reproductive technology is in vitro fertilization, where eggs are removed from the ovaries, fertilized in a laboratory by sperm cells, and then transferred into the uterus.12-14
Coping with infertility
Infertility can impact many aspects of a woman’s overall health beyond her reproductive system. When a woman or couple struggles with infertility, it can cause emotional distress and lead to mental health-related issues, such as depression, anxiety, loss of identity, or poor self-esteem.15-17 All of these factors can take a toll, and greatly impact emotional well-being. Coping with infertility can be a lifelong process, and one that takes time and care. Several mechanisms that may be used to cope with infertility, and that can be used by individuals or couples, include the following:
Allowing yourself or your partner to feel the overwhelming emotions that can accompany infertility and tackling them head on.
Building a strong support network of individuals you feel comfortable confiding in. Support networks can also be built from in-person or online support groups with other women or couples struggling with infertility.
Reestablishing and maintaining intimacy with your partner beyond your attempts to conceive.
Taking care of your physical and mental health through eating a balanced diet and exercising regularly.
Schrager S, Falleroni J, Edgoose J. Evaluation and treatment of endometriosis. American Academic of Family Physicians. 2013; 87(2), 107-113. Available from: https://www.aafp.org/afp/2013/0115/p107.pdf. Accessed March 29, 2018.
Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: A committee opinion. Fertil Steril. Sep 2012; 98(3), 591-8.
Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. Aug 2010; 27(8), 441-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/. Accessed June 5, 2018.
European Society of Human Reproduction and Embryology. Women with Endometriosis Need Special Care During Pregnancy to Avoid Risk of Premature Birth. EurekAlert: American Association for the Advancement of Science. https://www.eurekalert.org/pub_releases/2009-07/esfh-wwe063009.php. Published July 1, 2009. Accessed March 29, 2018.
Maggiore ULR, Ferrero S, Mangili G, et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Human Reproduction Update. 1 Jan 2016; 22(1), 70-103. Available from: https://academic.oup.com/humupd/article/22/1/70/2457880. Accessed March 29, 2018.
Wood R, Guidone H, Hummelshoj L. Myths and misconceptions in endometriosis. Endometriosis.org. http://endometriosis.org/resources/articles/myths/. Accessed March 29, 2018.
Petresin J, Wolf J, Emir S, Muller A, and Boosz AS. Endometriosis-associated maternal pregnancy complications-Case report and literature review. Geburtshilfe Frauenheilkd (English Print). Aug 2016; 76(8), 902-5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999325/. Accessed March 29, 2018.
Endometriosis. U.S. Department of Health and Human Services: WomensHealth.gov. https://www.womenshealth.gov/a-z-topics/endometriosis. Published March 16, 2018. Accessed March 17, 2018.
The Effect of Endometriosis on Fertility and Infertility. Advanced Fertility Center of Chicago. https://www.advancedfertility.com/endometriosis.htm. Accessed March 23, 2018.
Wood R. Infertility. Endometriosis.org. http://endometriosis.org/endometriosis/infertility/. Accessed March 23, 2018.
Infertility. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317. Published March 8, 2018. Accessed June 5, 2018.
Lifestyle Changes that May Boost Fertility. University of Wisconsin Health: Reproductive Endocrinology and Infertility. https://www.uwhealth.org/infertility/lifestyle-changes-that-may-boost-fertility/50420. Accessed June 1, 2018.
Female Infertility. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313. Published March 8, 2018. Accessed March 29, 2018.
Conditions Treated: Infertility. UCLA Health: Obstetrics and Gynecology. http://obgyn.ucla.edu/infertility. Accessed March 29, 2018.
Infertility. World Health Organization. http://www.who.int/reproductivehealth/topics/infertility/keyissues/en/. Accessed June 1, 2018.
The psychological impact of infertility and its treatment. Harvard Health Publishing. Harvard Medical School. https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment. Published May 2009. Accessed June 1, 2018.
Ezzell W. The impact of infertility on women's mental health. North Carolina Medical Journal. Nov-Dec 2016; 77(6), 427-8. Available from: http://www.ncmedicaljournal.com/content/77/6/427.short. Accessed June 1, 2018.