Can You Get Pregnant with Endometriosis? Heres what to Know

Curated by Claudia Shannon / Research Scientist / ishonest

If you’re living with endometriosis, the lining of your uterus (aka the endometrium) grows in other parts of your body where it doesn’t belong. This often leads to pain and sometimes fertility issues.

So if you have pregnancy on the brain, you might be worried about how this rogue endometrial tissue will mess with your chances of conception .

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Have endo but want a bun in the oven? We’ll fill you in on how to get pregnant when you have endometriosis.

Why is it hard to get pregnant with endometriosis?

Some research estimates endometriosis could be to blame for as many as 50 percent of infertility cases. Other studies suggest it may be a factor in 5 to 15 percent of cases.

So what gives? Endometriosis often affects fertility because it invades your reproductive system, including:

  • ovaries
  • fallopian tubes
  • the area around your uterus
  • cervix
  • vagina
  • vulva

In the process of conception, an egg is released from your ovaries during ovulation and then has to travel through your fallopian tube to your uterus, where it implants. While the egg is en route to your uterus, sperm travels through your cervix to hook up with that egg in one of your fallopian tubes.

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Endometriosis (or the associated swelling and scar tissue) may block the path, making that fateful hookup less likely.

Endo may also impact the baby-making process in these other ways:

  • Endometrium in the uterus (where it’s *supposed* to be to make a comfy home for your fertilized egg) may not develop properly.
  • Chronic inflammation can reduce fertility.
  • Scar tissue can impair ovulation.
  • The condition may trigger an immune response that attacks the embryo.

Can you get pregnant with stage 4 endometriosis?

Yes, but it’s complicated. In severe endometriosis, the tissue is deeply implanted in your pelvic area and reproductive organs. This typically makes it impossible to get pregnant naturally, because there are just too many obstacles.

If you have stage 4 endo, you’ll likely need medical attention such as surgery and/or assisted reproductive technology (ART) to make pregnancy possible.

Got baby fever? When to talk with your doc about getting pregnant

If you’ve already been diagnosed with endo
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Generally, doctors don’t diagnose or treat infertility until you’ve been trying to get pregnant for 6 months to a year. But if you know you have endometriosis, talking with your doctor and a fertility specialist can help.

When you’re ready to start trying, hit up your medical team so they can help you come up with a game plan.

If you’re taking medication to treat endometriosis (like birth control pills or other hormonal meds), they likely prevent ovulation. You’ll want to talk with your doc about how your meds affect fertility and whether you should stop taking them if you’d like to get pregnant.

Having a known complication like endometriosis means it’s important to partner with your medical team to get the best outcome. They’ll help you develop a plan for trying to conceive, which could involve surgery and fertility treatments.

If you haven’t been diagnosed with endo
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If you suspect endometriosis is to blame for your infertility, chat with your doctor. They can diagnosis endometriosis and determine whether surgery or other treatments can help you get pregnant.

Symptoms that might indicate endo:

  • painful period cramps
  • chronic pelvic pain or lower back pain
  • pain during or after sex
  • painful urination or bowel movements
  • intestinal pain
  • bleeding between periods
  • digestive problems, especially during your period

How can you get pregnant with endometriosis-related infertility?

If you’ve been knocking boots for 6 months to a year and haven’t gotten your eggo preggo, surgical options and/or fertility treatments are likely to be your next step.

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Your doctor or fertility specialist might suggest the following treatments:

  • Conservative surgery. A doctor can surgically remove bits of endometrial tissue while protecting the function of your reproductive organs.
  • Freezing your eggs. Because endo can reduce the number of viable eggs in your ovaries, you may want to preserve some for pregnancy in the future.
  • Hysterosalpingogram. A doctor will inject dye into your uterus and take X-rays to see if your fallopian tubes are open.
  • Medication. Fertility drugs like clomiphene citrate can induce ovulation or increase the number of eggs you produce at one time, increasing your chances of conception.
  • Ultrasound. By scanning your ovaries every few days, a fertility specialist can tell how your eggs are developing and the best time to try to conceive.
  • Intrauterine insemination (IUI). This procedure involves placing semen directly in your uterus close to ovulation to increase the odds of fertilization.
  • In vitro fertilization (IVF). After you receive drugs to stimulate your ovaries, a healthcare pro will remove your eggs and fertilize them in a lab. Successfully fertilized eggs will then be implanted in your uterus.

What’s the success rate of getting pregnant with endo?

Ready to roll the dice on pregnancy? There are a few different ways to look at how endometriosis will affect your chances of getting pregnant.

According to a 2014 review, 2 to 10 percent of couples dealing with endo will have children in their lifetime, compared with 15 to 20 percent for fertile folks.

For those who have endometriosis and don’t have surgery, studies estimate that pregnancy rates are about 33 percent with moderate endo and 0 percent with severe endo. But having surgery may increase your odds.

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Studies suggest that laparoscopic surgery to treat moderate endometriosis increases pregnancy rates to 57 to 69 percent. For people with severe endometriosis, the chance goes up to 52 to 68 percent after surgery.

IVF may improve those odds even further, but it’s not a guarantee. In a 2005 study, 56 percent of women with moderate to severe endometriosis got pregnant after 1 to 4 IVF treatments, and about 40 percent actually gave birth. But it’s been tough for researchers to determine exact percentages.

How to naturally improve your conception chances

Beyond medical treatments, improving your fertility with endometriosis is basically the same as improving fertility in general.

Here are some tips to boost your well-being and chances of getting pregnant:

  • Eat a varied diet to hit all your essential nutrients.
  • Track your cycle to plan sex around ovulation.
  • Keep your body moving with daily exercise.
  • Take steps to reduce stress (hello, yoga and meditation!).
  • Get enough sleep.

How will endometriosis affect your pregnancy?

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Having endometriosis doesn’t guarantee that you’ll have pregnancy complications. But complications are possible, so your doctor may recommend extra monitoring during your pregnancy.

A 2017 study of more than 19,000 births found that people with endometriosis had a higher risk of severe high blood pressure, hemorrhage, problems with the placenta, and premature broken waters.

The babies in the study had an increased risk of being born before 28 weeks’ gestation, small size for gestational age, congenital malformations, and death.

Having endometrial surgery before pregnancy also comes with increased risks. One study found that people who had surgery to treat endometriosis were more likely to have placenta previa, a condition in which the placenta blocks the cervix, making vaginal delivery risky and warranting a cesarean delivery.

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According to a 2018 research review, endometriosis is also associated with higher risk of gestational diabetes, cesarean delivery, and neonatal intensive care unit admission for the baby.

Will your kids also have endometriosis?

There does seem to be hereditary link to endometriosis.

Studies of people with confirmed endometriosis have shown “familial clustering.” It’s estimated that siblings, parents, and children of people with endometriosis are 5 to 7 times more likely to have endo than people who don’t have a first- degree relative with the condition.

So if you give birth to a female kiddo (and your mom, sis, or aunt also has endo), it *is* possible your kid could have it too.

The takeaway

Endometriosis makes getting pregnant more difficult — but not impossible.

For the best chance at pregnancy, take steps to stay generally healthy and keep your healthcare team in the loop about any conception plans. You may need surgery or fertility treatments to get pregnant if you have endometriosis.

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