Can You Get Pregnant with Endometriosis? Yes – Here’s How

If you have endometriosis, you may have heard that getting pregnant is difficult. But do you know the following? 

• An estimated 50% of women with mild endometriosis (and 25% of women with moderate endometriosis) conceive naturally without intervention.

• Women undergoing in vitro fertilization (IVF) with endometriosis have a 44.6% chance of getting pregnant with each embryo transfer.

So the short answer is yes. If you have endometriosis, pregnancy is possible. However, the path to pregnancy may not be straightforward, and specialized treatment may be necessary. 

Understanding Endometriosis

Endometriosis is a condition that affects approximately 10% of women of reproductive age. It occurs when tissue similar to the endometrium (the layer of tissue that lines the inside of the uterus) grows outside the uterus. Endometriosis can reach any part of the body, but it is most commonly found in the following areas:

• Ovaries

• Uterine tubes

• Bladder

• Pelvis

Similar to the endometrium, endometriosis tissue responds to hormonal changes. This means it thickens and bleeds every cycle during menstruation. However, unlike your menstrual flow, the tissue has no way to exit the body. This can lead to inflammation, scarring, and pain. 

If you have endometriosis, you may experience the following symptoms: 

• Severe pain and cramping during menstruation

• Heavy periods

• Pain in the lower back and pelvic area

• Pain while using the bathroom

• Pain during and after sex

• Difficulty getting pregnant

It’s also possible to have endometriosis but not experience any symptoms at all. In fact, researchers estimate that 20-25% of endometriosis patients are asymptomatic. 

Endometriosis and Fertility

Endometriosis can sometimes make it more difficult to conceive. Here’s why: 

• Inflammation can be harmful to sperm and eggs. Inflamed tissue caused by endometriosis releases cytokines. Cytokines are proteins that help the body control inflammation, but they can also cause harm to eggs and sperm. This makes fertilization more difficult. 

• Scar tissue can block uterine tubes. Sometimes excess tissue caused by endometriosis can grow throughout the uterine tubes. This makes it difficult for a sperm to travel to the egg for fertilization.  

• High estrogen levels may interfere with ovulation. Endometriosis is linked to high estrogen production. This disruption in hormone levels can prevent the body from releasing an egg during ovulation.  

A common misconception about endometriosis is that the severity of symptoms is somehow linked to the chances of getting pregnant. However, it’s possible to have severe endometriosis symptoms and be able to conceive naturally. It’s also possible to have mild symptoms (or no symptoms at all) and struggle to conceive. 

The Stages of Endometriosis and Chances of Conception 

Following laparoscopic surgery, a doctor can diagnose endometriosis and assign a stage based on the nature and progression of the condition. 

During laparoscopic surgery, a tube with a small camera is inserted into the abdomen. A doctor then looks for evidence of endometriosis in the pelvis; removing excess tissue where possible. 

Here’s a closer look at each endometriosis stage.

Can You Get Pregnant Naturally With Endometriosis?

Yes, you can get pregnant naturally with endometriosis. However, your chances of getting pregnant depend on how severe the condition is. 

Here’s what the research suggests:

• If you have mild endometriosis, you have an estimated 50% chance of conceiving naturally without intervention.

• If you have moderate endometriosis, you have an estimated 25% chance of conceiving naturally without intervention.

• If you have severe endometriosis, the chances of conceiving naturally without intervention are very low. However, IVF is a viable alternative. 

Remember — the severity of endometriosis is not necessarily correlated to the severity of your symptoms. The best way to understand the potential impact of endometriosis on your fertility is with laparoscopic surgery and a consultation with your doctor. 

Endometriosis and Pregnancy

Potential Risks to Be Aware Of

The majority of people pregnant with endometriosis will go on to have successful pregnancies. 

However, research does show the rate of miscarriage is slightly higher among women with endometriosis (35%) compared to women without endometriosis (22%). Other pregnancy risk factors include:

• Ectopic pregnancy (up to 90% greater risk)

• Spontaneous abortion (up to 75% greater risk)

• Preeclampsia (up to 37% greater risk)

• Gestational diabetes (up to 26% greater risk)

• Preterm birth (up to 55% increased risk before 37 weeks)

If you become pregnant with endometriosis, your doctor may want to monitor your pregnancy more closely. This is normal. Regular check-ups will help ease your concerns and allow your doctor to address complications early on. 

Temporary Symptom Relief

After conception, hormone patterns shift to support your pregnancy. Hormones like estrogen and progesterone no longer follow a cyclical pattern. Instead, they steadily rise until reaching a peak in your third trimester. This is why your period and ovulation stop during pregnancy. 

If you have endometriosis, this change in hormone patterns may provide you with some temporary pain relief. This is due to elevated progesterone levels, which can help suppress the growth of endometriosis tissue and reduce inflammation. However, research shows it’s not a guarantee that pain will go away completely. As the body physically changes during pregnancy, patches of tissue can become pulled or stretched, which may be painful. 

In the long term, pregnancy itself will not cure endometriosis. As your hormones return back to their pre-pregnancy levels, endometriosis symptoms are also likely to return. This is something your doctor can help you with as part of your postnatal care. 

Strategies for Improving Your Chances of Conception With Endometriosis

Natural Ways to Boost Fertility

Remember — if you have mild endometriosis, you have a one in two chance of conceiving naturally without intervention. If you have moderate endometriosis, your chances are one in four. 

Even though endometriosis is completely out of your control, there are things you can do to maximize your chances of conceiving naturally. Here are a few strategies worth considering: 

• Follow an Anti-Inflammatory Diet. This is sometimes referred to as the “Endo Diet,” and it incorporates foods high in omega-3 fatty acids, vitamin C, polyphenols, prebiotics, probiotics, and fiber. This can help reduce inflammation and promote hormone balance.

• Take Fertility Supplements. Certain vitamins and minerals (such as folate and iron) are associated with improved ovulatory function. Mira’s own Prenatal Multivitamin contains the right amount of iron and folate to boost your reproductive health — plus key nutrients necessary to set your pregnancy up for success. 

• Manage Stress Levels. Chronic psychological stress can affect the balance of estrogen and progesterone levels. To keep your stress levels under control, make time in your schedule to do something you enjoy — like reading, crafting, or yoga. For an extra boost of reproductive wellness, try Mira’s Fertility Tea alongside your next relaxing activity. 

• Try Endo-Friendly Sex Positions. You’re more likely to want to have sex with your partner if it’s pain-free (or at least less painful). Endo-friendly sex positions may help ease pelvic pain during sex.

Last but not least, it’s important to track your menstrual cycle so you can predict your most fertile days. This enables you to plan sex with your partner when you are the most likely to conceive. 

Here’s how you can do this:

• Track your cycle dates in a calendar or period tracking app (such as the Mira App) 

• Track changes to cervical mucus

• Track changes to basal body temperature (BBT) with a BBT thermometer

The most accurate way to predict your fertile window with endometriosis is by monitoring your hormonal fluctuations directly. With Mira, you can track your E3G (a urinary metabolite of estrogen), PdG (a urinary metabolite of progesterone), and LH (luteinizing hormone) levels at home. This enables you to predict your full six-day fertile window and ovulation date with lab-grade precision. 

Medication and Surgery

If you have stage 3 or stage 4 endometriosis, your chances of conception may improve following medical intervention.

For example, a common surgery for endometriosis is laparoscopic excision surgery. This surgery can remove any excess endometrial-like tissue from your reproductive organs. Research shows this increases the odds of spontaneous pregnancy. For stage 3 and stage 4 endometriosis, the probability of pregnancy is 46% and 44% within three years following surgery, respectively. One exception is the excision of endometriomas, which improves pregnancy rates but may have a negative impact on your ovarian reserves.

Hormonal treatments can also be helpful. For example, GnRH agonists may be recommended ahead of in vitro fertilization (IVF). Research suggests that GnRH treatments for up to six months before IVF may help to reduce inflammation and improve pregnancy outcomes. 

Assisted Reproductive Technologies (ARTs)

ARTs, such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF), can also help you conceive faster and more easily with endometriosis. 

IUI involves injecting your partner’s sperm directly into your uterus. This can help sperm avoid any blockage in the uterine tubes. IUI is most often recommended to patients with early-stage endometriosis. The pregnancy rate of IUI for endometriosis is estimated to be around 12%. To enhance the chances of conception, IUI may also be paired with fertility drug treatments, such as Clomid. 

If IUI with fertility drugs is unsuccessful, the next line of treatment is IVF. IVF involves implanting an already fertilized egg directly into the uterus. If you have endometriosis, research suggests you have a 44.6% chance of getting pregnant with each embryo transfer. However, success rates can vary greatly depending on your age and stage of endometriosis. 

Endometriosis and Conception: Overview of Treatment Options

When to See a Doctor and Next Steps

If you have never been diagnosed with endometriosis, you should speak with your doctor if you:

• Experience severe pain and cramping during menstruation that interferes with your day-to-day life

• Have periods that last for seven days or more

• Have heavy periods that bleed through your underwear or fill up a pad/tampon within two hours

• Have been trying to conceive for at least 12 months (if under age 35) or six months (if over the age of 35) without success 

If you have already been diagnosed with endometriosis, you should speak with your doctor if you:

• Have received treatment, but your symptoms have not improved

• Have been trying to conceive for at least 12 months (if under age 35) or six months (if over the age of 35) without success 

Your doctor can evaluate your symptoms, run further testing, and diagnose your stage of endometriosis. They can also provide tailored guidance on planning a pregnancy with endometriosis.

Conclusion: Taking Control of Your Fertility With Endometriosis

Endometriosis may make conception harder — but in many cases, it’s still possible.

Lifestyle adjustments and consistent cycle tracking can maximize your chances of conception if you have mild to moderate endometriosis. If you have moderate to severe endometriosis, your doctor may recommend laparoscopic excision surgery or IVF. 

If you have been trying to plan a pregnancy for at least 12 months (if under 35) or six months (if over 35) without success, speak with your doctor. They can assess your situation and provide specialized guidance on the next line of treatment. 

If you are struggling to navigate the practicalities of planning a pregnancy with endometriosis, you can also seek support from Mira’s Hormone Health Clinic. Our fertility specialists can help you track your cycle with Mira, make any necessary lifestyle changes, and manage your mental health throughout your TTC journey with endometriosis. 

Frequently Asked Questions

Can endometriosis kill you?

No. Endometriosis is not a fatal condition. However, it can lead to severe complications if left untreated. 

Does endometriosis cause infertility?

Sometimes. An estimated 20-50% of women with infertility have endometriosis. The chances of conception vary and depend on the severity of the condition. 

How to prevent endometriosis?

There is nothing you can do to prevent endometriosis. 

I’m trying to become pregnant with PCOS, fibroids, and endometriosis. How can I get help?

Speak with your doctor. They can provide specialist guidance on getting pregnant with PCOS, fibroids, and endometriosis. 

Is it true that a woman experiencing endometriosis and in their early 30s cannot get pregnant?

No. It’s still possible to conceive with endometriosis. However, it may be more difficult depending on your stage of endometriosis. 

Can an endometriosis stage IV patient conceive?

Yes. It may be possible to conceive with stage IV endometriosis. Doctors often recommend IVF for stage IV endometriosis patients who are TTC. 

Is there a stage 5 endometriosis?

No. The highest stage of endometriosis is stage 4. 

What is the best age to get pregnant with endometriosis?

The chances of conception are highest for anyone under 35. After 35, the chances gradually decrease. 

What is an endometriosis laparoscopy?

A laparoscopy for endometriosis is a minimally invasive surgery where a doctor looks for evidence of endometriosis in the pelvis and removes excess tissue where possible.