Endometriosis can be found in up to 50% of women who experience infertility, but the link between the two conditions still isn't completely understood.

By Maggie O'Neill
April 06, 2021
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Endometriosis is extremely common in the US: It's believed that more than 11 percent of women ages 15 to 55 may have the condition, according to the Office on Women's Health (OWH), a division of the US Department of Health & Human Services, and it's more common among women in their 30s and 40s.

The condition is characterized by abnormal tissue growth—specifically when tissue similar to that which lines the uterus (known as endometrium) grows outside of the uterus, like on the fallopian tubes, ovaries, cervix, bladder, and other organs in the body, usually nearest to the uterus.

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Credit: Getty Images / Design by Jo Imperio

That tissue, even when it grows outside of the uterus, still acts like it's inside the uterus—that means it thickens, breaks down, and bleeds with each menstrual cycle. For women with endometriosis, this can cause intense menstrual cramps, excessive bleeding during periods or bleeding in between periods, and even digestive issues, per the OWH.

Another symptom associated with endometriosis infertility. Johns Hopkins Medicine estimates that endometriosis can be found in 24 to 50% of women who experience infertility, making it one of the three major causes of female infertility. Sometimes, it's only temporary; other times, it's long lasting.

The effect of endometriosis on infertility still isn't completely understood, and it's important to keep in mind that, when experts discuss the topic of infertility and endometriosis, they're speaking about theories rather than proven facts rooted in substantial research, Dan Martin, MD, scientific and medical director at The Endometriosis Foundation of America (EndoFound), tells Health.

That said, experts think that one reason endometriosis might affect fertility is that it causes scar tissue, which can actually cause a physical barrier that prevents sperm from reaching the egg. "You can't get a meeting of the two [because of] a direct blockage," Ruben Alvero, MD, a professor of obstetrics and gynecology at Stanford University Medical Center, tells Health.

Because the endometrium—or the lining of the uterus—is affected with an endometriosis diagnosis, that may affect conception, too. That uterine lining is where implantation during pregnancy occurs—it's where the embryo attaches and grows until it's ready for delivery. But since endometriosis affects the development of the endometrium, it could prevent the successful implantation of a fertilized egg, according to the OWH. And even if an egg implants correctly, endometriosis may cause a person's immune system to attack the embryo in the uterine lining, ultimately leading to an unsuccessful pregnancy.

Still, it's important to remember that, despite some reasons why endometriosis may limit a person's ability to conceive, there's also a chance that someone's infertility isn't caused by endometriosis at all, says Dr Martin. That means a person can have endometriosis and another condition that causes infertility, without the two being linked.

If you've been diagnosed with endometriosis and are having a hard time conceiving, it's important to speak with your doctor, per the OWH. They might suggest surgery—like removing endometrial growths that could inhibit pregnancy—to improve your chances of conceiving. In-vitro fertilization is another option, according to the Cleveland Clinic, "since the egg and sperm are meeting in a petri dish," and aren't in an "inflammatory pelvic environment."

For people who are able to get pregnant with endometriosis, luckily, they're not necessarily at a higher risk for any pregnancy complications. Though delivering via Cesarean section may prove more difficult than a vaginal birth, due to endometrial growths, the pregnancy itself likely won't face complications due to endometriosis, since the uterus stretches slowly during pregnancy, says Dr. Alvero.

Regardless of any underlying conditions like endometriosis, it's important during any pregnancy to keep in close contact with your ob-gyn for the sake of your health along with your baby's.

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