Can you get pregnant with endometriosis? Yes, but here are 7 things to know

For women navigating fertility challenges, it’s estimated that endometriosis is prevalent in around 30-50 per cent of cases. It may be one of the most common fertility hurdles, but we’re super-keen to emphasise that it isn’t necessarily the end of the road. 

Can you get pregnant with endometriosis? Yes. But there are a few crucial factors to take into account, and work with. 

From testing to treatment, and everything in-between, the earlier we can diagnose and treat endometriosis, the better the outcomes when trying to conceive. That’s clear in the numbers, and in the treatment room. 

Life has a way of screwing up our timings and plans, however, and with access to testing still suboptimal, and family planning on very different timelines, in 2024 it just isn’t always possible to get that early diagnosis and treatment in place. 

Expert insight

Picking up with us on this super-high priority topic today is reproductive specialist Dr. Marco Gaudoin, Medical Director at TFP Fertility. Catch his webinar here with TRB founder Eloise, and pick and choose from the highlights in our deep-dive Q&A, starting with the all-important one – is it possible to get pregnant with endometriosis? And if so, what should we know when planning a pregnancy? 

1. Our number one question – can you get pregnant with endometriosis?

Yes, but there are several factors to bear in mind, if you’re in the planning stages. It’s really important to emphasise that the sooner you have fertility treatment, the younger you’re going to be, and the better your chances of having a baby. So if you think you may have endometriosis, seek expert support as soon as you can.

I’ll dive straight into the medical management of endo and fertility outcomes, here (keep reading for my notes on natural conception). 

When it comes to infertility treatment, there’s unfortunately no place for medical suppression of endometriosis. While effective for pain management, in fertility terms suppression means a delay in treatment, and age, as we know, is so important. 

Surgery itself is contentious. If you have pain, then surgery has a place. But otherwise by waiting for surgery, all you’re doing is getting older.

IUI may have a place with stage 1 or stage 2 endometriosis, but only really in women who are using donor sperm. And with stage 3 and stage 4, even if using donor sperm, IVF treatment has the best outcomes. 

2. What about getting pregnant naturally?

My number one guideline here is to assume nothing – women with endometriosis can and do conceive naturally, but the disease does also present significant challenges, when planning to have a baby.

If you think (or know) you have endometriosis, seek help sooner rather than later, because the younger you are when you have fertility treatment, the more successful it’s likely to be.

For stage 1 or stage 2 disease, where pain is the primary symptom, you could still conceive naturally. But unfortunately, each month you’re trying, you’re getting that much older. It’s a real dilemma, because the NHS requires you to try naturally for two years before you can get access to fertility treatment. And in that time, your early stage endometriosis may simply be getting worse.

I see this as a bonkers sort of approach, because with severe endometriosis, the chances of getting pregnant naturally are minimal. So as I said (and it really does bear repeating!), the sooner you have fertility treatment, the younger you’re going to be, and the better your chances of having a baby.

3. Can I get pregnant with an endometriosis cyst?

In general, cysts themselves don’t make conception more difficult. However, if the underlying cause of the cyst is endometriosis, this does affect your chances of conception.

For example, an endometriotic cyst located on your ovary may also affect your fallopian tube, and even be classed as stage 3 or 4 (severe) endometriosis.

You can remove an endometriosis cyst, with what we call a cystectomy. The risk here is that you’re inevitably going to remove good ovarian tissue as well, which for fertility, we want to avoid.

Keen to discuss a cyst, treatment or endo in general? Skip straight to TFP Fertility for expert support and nationwide availability.

4. What should I know about surgery?

Again, surgery is a contentious topic in fertility. One of the key issues is the wait time involved, especially on the NHS, because delay and age are a real concern. Traditional surgery is also invasive, and this can have a negative impact on fertility.

Sclerotherapy is a newer approach, and one which may have real benefits – you’re injecting alcohol into the endometriosis, rather than stripping it out and risking damage to the uterine tissue.

The best approach when it comes to surgery, is to seek out a gynaecologist who has a proven track record in endometriosis surgery and the very latest techniques, such as sclerotherapy.

5. And what about conception after surgery – do I need to allow recovery time?

It depends on the extent of the surgery and the recovery your physician sets in place. But in general, the sooner you can have fertility treatment after your surgery, the better.

This is because, sadly, endometriosis just marches on. The longer you leave it, the more likely it is to recur.

6. Can endometriosis resolve itself?

Pregnancy does suppress endometriosis, mainly because of high progesterone levels through the course of the pregnancy. However, menopause is the only ultimate stop on endometriosis.

With menopause, you don’t have that monthly hormonal stimulation from oestrogen that is causing the endometriosis to proliferate.

7. How should I go about the endo conversation with my doctor – anything specific I should ask for?

Great question!

In your appointment, my advice is to go with something like:

“I’m really concerned that I might have endometriosis, and I know that endometriosis has an impact on my fertility, so please refer me accordingly.”

Your doctor should then discuss your symptoms, and work with you towards a referral or support as quickly as possible. Time really is the crucial factor here, so feel free to stress the urgency, and any or all of the aspects covered in our webinar.

Next steps

Endometriosis isn’t a hard stop on fertility, but it does require expert support and guidance, as well as a thorough understanding of your timescales, by your GP or fertility team. Get the ball rolling, with these to-dos:

• Find out more about endometriosis with expert fertility support and book a session with TFP Fertility today (whether it’s with Dr. Marco Gaudoin in Glasgow or another of their world-leading team from across the UK)
• Catch our medical director’s endometriosis and fertility tool kit – from age factor to specialist treatment, the role of diet and more
• Read TFP Fertility patient Annabelle Jones’ real life success story, covering solo mamahood, endometriosis, keeping hope, and getting started (and find her on Insta)