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Endometriosis and Pregnancy

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If you have endometriosis, you've probably asked yourself or your health care provider: "How could this affect my ability to get pregnant?" That's a good question. The simple answer is that it may make it harder for you to get pregnant. Studies find that about 21 to 44 percent of infertile women have endometriosis, but only 4 to 22 percent of fertile women. What we don't know, however, is if it is the endometriosis itself that impacts a woman's ability to get pregnant, or something else at work. It also doesn't mean you won't or can't get pregnant.

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Here's a brief overview of what we do know, what we think might be going on, and what steps you can take to get pregnant and have a healthy pregnancy and baby.

Will having endometriosis make me less fertile? As noted before, it's possible. There is some evidence that women with minimal or mild endometriosis are less fertile than other women. Certainly researchers see it in baboons, our closest animal cousin when it comes to such things. Plus, we do see that the worse the endometriosis, the worse the fertility rate in women. We even see this in women who undergo artificial insemination, in which the sperm is placed directly in the uterus, where it has the best chance of meeting up with an egg.

What is behind the link between fertility problems and endometriosis? Not sure. One theory that's getting a lot of attention suggests it may be related to an underlying immune condition that increases inflammation. Inflammation is caused, in part, by chemicals called cytokines, released when the immune system sweeps in to fix a problem. Endometrial tissue outside the uterus is certainly one of those problems! And, in fact, studies find higher levels of cytokines in the fluid within the peritoneum, which encloses the gastrointestinal and reproductive organs. Other studies suggest that high levels of cytokines can negatively affect not only fertility, but the outcome of pregnancy and the health of embryos. Cytokines can also affect the health of your eggs, with studies finding that women with endometriosis have more problems related to their ability to produce healthy eggs than those without. Unhealthy eggs are much less likely to lead to a pregnancy even if a sperm reaches them.

The inflammatory theory also gets support from baboon studies, which found endometriosis and endometriosis-related infertility improved when the animals received anti-inflammatory treatment. Studies in women are now focusing on the potential benefits of anti-inflammatory drugs to treat endometriosis.

Can I undergo assisted reproductive techniques like IVF if I have endometriosis? Definitely. In fact, IVF and similar techniques offer a very good option for women with endometriosis. However, you should know that success rates of IVF in women with endometriosis are nearly half those of women with other reasons for their infertility. Just as with the whole fertility/endometriosis connection, however, we still don't know exactly what is behind these lower success rates. One bright spot in this area (although the research is still preliminary) comes with intracytoplasmic sperm injection (ICSI). In this procedure, a single sperm is injected into the egg, then the resulting embryo is implanted in the uterus. Two studies suggest success rates in women with endometriosis are similar to those in women without the condition.

So what should I do if I want to have a baby? Start early. Although I don't have the studies to prove it in women with endometriosis, we do know that women overall are much more likely to get pregnant when they're in their twenties than when they are in their thirties and forties. Since you already know you have a greater risk of fertility problems than a woman without endometriosis, you want to stack the deck in your favor. That means starting a family earlier rather than later. Also focus on your overall health. A woman who maintains a healthy weight, eats a healthy diet high in fruits, vegetables and whole grains, and gets regular exercise, has a body prepared to nourish an embryo. Your reproductive system picks up on this; it's why very underweight or overweight women, or women who are malnourished, are less likely to get pregnant—their bodies are not in good shape for pregnancy.

I also recommend that you see an infertility specialist sooner in your quest to have a child rather than later. If you've been trying for six months and the stick still hasn't turned pink, make an appointment.

Above all, don't panic! Every day brings us information about new treatments and options when it comes to getting women—even women with endometriosis—pregnant and helping them deliver healthy babies.