Does Endometriosis Cause Infertility?

“It’s just PMS.” “That’s normal.” “Try a heating pad.”

Women are often told their painful periods are just part of a normal menstrual cycle. But when pelvic pain interferes with daily life or is accompanied by difficulty getting pregnant, it may be related to something more serious. Endometriosis affects about 10% of women yet remains widely misunderstood.

Understanding endometriosis’ causes and symptoms, as well as the treatment options available, can help you navigate the condition.

What Is Endometriosis?

“Endometriosis is a gynecologic condition where cells similar t​​o the lining of the uterus grow outside the uterine cavity and can implant anywhere in the pelvis,” explains Elisabeth Schleuning, M.D., an OB/Gyn with Sutter Health who specializes in minimally invasive gynecologic surgery.  

It can grow on the ovaries, fallopian tubes and pelvic tissue as well as the bladder, bowels and appendix. When the surrounding tissue becomes irritated, scar tissue can form. Adhesions, which are bands of fibrous tissue, can appear and cause organs to stick together.  

Endometriosis Causes and Symptoms

Experts don’t know the exact cause of endometriosis. Researchers have theories and are studying genetics, immune system issues, hormones and the impact of abdominal surgery. Another theory is that it’s caused by menstrual blood flowing through the fallopian tubes and into the pelvic cavity, rather than leaving the body.  

Symptoms of endometriosis include:  

• Digestive problems such as diarrhea, constipation or bloating, especially during menstrual periods
• Heavy menstrual periods or bleeding between periods  
• Infertility or difficulty conceiving
• Pain during or after sexual intercourse
• Painful periods
• Pelvic pain during urination or bowel movements

“One thing we know about endometriosis that’s interesting and confusing is that the amount of endometriosis one has does not necessarily correlate with the amount of pain that they have or the symptoms that they have,” Schleuning says. “Someone can have just a few little implants of endometriosis with a huge amount of pain. Conversely, people can have a lot of pelvic scar tissue and organs stuck together, and they might not feel that bad, but they might have difficulty conceiving.” 

Does Endometriosis Cause Infertility?

The definition of infertility in a person younger than age 35 is trying for a full year without conceiving. For people over 35, infertility is defined as six months of trying to conceive without being successful.

About 30% to 50% of women with endometriosis experience infertility. Endometriosis can affect fertility by changing pelvic anatomy, scarring fallopian tubes, altering egg quality, impairing implantation of the embryo and more.

Endometriosis Stages and Fertility

Regardless of endometriosis’s causes and symptoms, there’s only one way to diagnose the condition, which is through surgery.

​​​“It’s a little easier to see endometriosis with robotic surgery than with conventional laparoscopic surgery because of its 3D high-definition views,” Schleuning says.  

During surgery, your doctor will assess the stage of the endometriosis — minimal (stage 1) to severe (stage 4). The staging relates to the likelihood of getting pregnant.  

“When someone has stage 4 endometriosis, they have more severe disease, and that includes a lot of scar tissue, things stuck together and adhesions, which can affect their fallopian tubes,” Schleuning says. “When endometriosis goes to the fallopian tubes, it can cause swelling in the tubes that makes the tubes dysfunctional. Those people are at higher risk for an ectopic pregnancy, as well as difficulty conceiving in general.”

With more advanced endometriosis, more aggressive fertility treatment options may be considered.

Treatment Options for Endometriosis

The good news is that there are treatments for endometriosis. Your doctor will personalize treatment based on your condition as well as your pregnancy plans.

For example, birth control or other medical therapy can improve symptoms, but if you want to get pregnant soon, this option may not make the most sense for you. Endometriosis can also be surgically removed, increasing the odds of conceiving. In addition, conceiving through in vitro fertilization (IVF) is another option for people with endometriosis.  

“If you're trying to get pregnant and you're over 40, go to an infertility specialist,” Schleuning says. “And know that even if you have horrible endometriosis, there are options to help you conceive.”