Endometriosis is a disease that affects the female reproductive system, leading to pain and possibly infertility. It occurs when the tissue that normally lines the uterus develops outside of it, usually on the ovaries, the fallopian tubes (tubes connecting the ovaries to the uterus), or the tissue lining the pelvis. The exact cause of the development of endometrial lesions is not fully understood.
How endometriosis affects pregnancy
After pain — including during and after sex — difficulties with fertility are a common symptom of endometriosis.
Although many women with endometriosis become pregnant naturally without any problems, statistically, it takes them longer to become pregnant and some may not be able to conceive.
It is not entirely understood what causes a reduction in fertility. Scientists suspect that the condition may inhibit the movement of the eggs along the fallopian tubes, or that the eggs themselves may be affected. Another reason might be inflammation of the pelvis, which lessens the lifespan of sperm.
Problems with fertility correlate with the severity of endometriosis. The more severe the disease, the more likely it is that a woman will have difficulties becoming pregnant.
Treatment for endometriosis-related infertility
Removing endometriotic tissue can ease problems with fertility in women with mild endometriosis. The tissue is removed during a surgical procedure known as laparoscopy.
Women with moderate or severe endometriosis who undergo such surgery are still less likely to conceive than those with mild disease, although surgery may improve their chances of becoming pregnant.
Changes that occur during pregnancy
Many women with endometriosis report that disease symptoms ease during pregnancy, especially in the later months. This may be because the levels of the hormone progesterone rise during pregnancy, which can suppress the growth of endometriotic tissue. Another reason might simply be the absence of the menstrual cycle.
After pregnancy, breastfeeding inhibits the release of estrogen by the ovaries, which hinders both ovulation and the growth of endometrial lesions. Pain and other symptoms of endometriosis are usually milder while women breastfeed their babies.
However, pregnancy-associated relief is often temporary and symptoms return after delivery. For some, symptoms return with the resumption of the menstrual cycle.
Some women report a worsening of symptoms during the early months of pregnancy. This may be due to the rapid growth of the uterus to support the fetus, which causes pulling and stretching of scarred tissue. Estrogen is also produced at high levels during pregnancy, and some suspect this initially stimulates the growth of endometrial lesions.
Is pregnancy risky with endometriosis?
Pregnancies take a regular course in women with endometriosis, and the condition is not associated with risks for the baby. Some researchers have suggested that endometriosis increases the risk of preterm birth, but such an association is not established. Most patients deliver healthy babies.
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