Living with endometriosis comes with many challenges. Symptoms can be far-ranging and painful - and treatment can be complex. Beyond this, fertility can be a concern. Many women wonder: Can I have a baby? If so, what are my chances? Do I need to explore reproductive technology options? The short answer is yes - you CAN become pregnant with endometriosis. This can be achieved through many different avenues. Let's dive into this topic deeper.

What is endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. These areas may include the ovaries, bladder and bowel. This abnormal tissue growth can lead to inflammation and the formation of scar tissue called adhesions.  

Endometriosis is a challenging disease to treat and can often be seen as an enigma to both patients and providers. There is no one clear path on how to live with, diagnose, or treat endometriosis – each course of action is highly customized to the person experiencing the disease. 

How does endometriosis impact fertility?

If you have endometriosis, it may be more difficult for you to become pregnant than someone without endometriosis. Up to 30% to 50% of women with endometriosis may experience infertility. Endometriosis can influence fertility in several ways, including:

• Changes in the anatomy of the pelvis

• Adhesions on reproductive organs

• Scarred fallopian tubes

• Inflammation of pelvic structures

• Changes in the hormonal environment of eggs

• Reduces egg quality

Endometriosis affects women differently, and to different degrees. Your doctor will grade your endometriosis by stage on a scale of 1-4, with Stage 1 being least severe and Stage 4 being most severe. In general, the higher the stage, the higher the impact on fertility. Women with severe (Stage 4) endometriosis, which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty becoming pregnant and often require advanced fertility treatment.

It's important to note that endometriosis is a disease that occurs outside of the uterus. Having a hysterectomy (removal of the uterus) does not treat endometriosis. If you are being given that treatment option, it is important to seek out an endometriosis specialist who can offer more effective options that also spare reproductive organs.

All that being said: Know that women can and do conceive naturally with endometriosis.

If I have trouble getting pregnant naturally, what are my options?

Women who have been diagnosed with endometriosis or have suspected endometriosis should see a Reproductive Endocrinologist or Fertility Specialist as soon as possible to assess their fertility. They will conduct various tests to determine the reproductive technology options available to you. These options may include:

• Egg Freezing - Freezing your eggs is a great option available for those who are concerned about the potential impact of endometriosis on their eggs, but are not yet ready to try to conceive. Egg freezing "stops" your biological clock, meaning that any eggs you freeze now will have the same reproductive potential as when they were frozen. So, if you decide to attempt pregnancy at age 40 using eggs you had frozen at 28, you will be using eggs preserved at a time when they were at their healthiest, giving you higher chances of success.

Egg freezing involves five phases: 1. Determining your treatment plan. 2. Ovarian stimulation. 3. Egg retrieval. 4. Cryopreservation (freezing) and storage. 5. Thawing and fertilizing those eggs to achieve a pregnancy.

• In Vitro Fertilization (IVF) - IVF has been shown to be one of the most successful treatment options for women with endometriosis who are struggling to conceive. With IVF, medication is used to stimulate egg production, and then a minor procedure is performed to remove the eggs from the ovaries. They are then fertilized by sperm in a laboratory to create an embryo, which is implanted into the uterus.

• Intrauterine Insemination (IUI) - IUI is an effective option for those who have normal (no damage or minimally damaged) fallopian tubes, mild endometriosis, and whose partner has sperm with no fertility issues. Sperm donation is also an option when using IUI. IUI allows for better sperm delivery to the fallopian tube - essentially getting the sperm and egg closer to each other to increase the odds of fertilization. IUI treatments are typically used in combination with medications that increase the number of eggs per cycle and trigger ovulation.

• Using a Gestational Carrier - A gestational carrier - previously referred to as a "surrogate" (which is now an outdated term) - is a person who carries a pregnancy to term for another family. A gestational carrier has no biological link to the individual or couple looking to start a family. If you've had your uterus removed, this is an excellent option for starting a family.

Keep in mind that it's also important to follow the endometriosis treatment plan recommended by your doctor, and to try and live as healthy a lifestyle as possible.

If family planning is on your mind, the sooner you seek out the guidance of a Fertility Specialist, the better. Rest assured that conceiving naturally is possible - and that many options are available if you need assistance in achieving your family goals.