Written by: Andrea Reh, M.D.
Lena Dunham’s recent press about her struggle with endometriosis brings this common condition to the spotlight. So, let’s say you have endometriosis, now what should you do and what are the treatment options for getting pregnant with endometriosis?
There are several factors that help us to make decisions about your treatment. Whether or not you have pain and whether or not you are trying to conceive are important questions that guide your treatment options, and which type of doctor might be best for you. Getting pregnant with endometriosis is very possible for most women. While endometriosis may make it harder to conceive on your own, your chances of getting pregnant with endometriosis can be high, depending on the severity of your condition, your age, your overall health, and your treatment options.
Since endometriosis can take many forms, and the success rates of treatments vary, your doctor will outline your best treatment options with an individual plan for you.
I have pain, but I’m not trying to get pregnant yet.
If you are experiencing pain because of your endometriosis and you are NOT trying to conceive, your gynecologist can prescribe a variety of hormonal medications that can help alleviate the pain. If medications are unsuccessful, you may want to consider having surgery if you have not done so before, and we would recommend doing so in the hands of a surgeon who is experienced in endometriosis—and laparoscopy in general. This may be your gynecologist or another experienced surgeon.
If you know you want to have a baby at some point, but not right now, then you should also be aware that there are options to preserve your fertility through egg freezing at this point in time. Recognizing that the number of eggs a woman has will decrease over time, and recognizing that endometriosis does tend to worsen with time, many women are now choosing to proactively freeze their eggs in the event that their endometriosis threatens their fertility in the future. Also, while laparoscopic surgery can help to reduce the pain associated with endometriosis, it can also negatively affect your ovarian reserve. Therefore, freezing your eggs prior to surgery ensures you have options in the future. This is a conversation to have with a fertility specialist who can best guide you in your decision making process.
I have pain, and I’m trying to get pregnant.
For any woman who has or suspects endometriosis and is seeking to get pregnant, we recommend seeing a fertility specialist sooner rather than later. With proper counseling and care, the chances of getting pregnant with endometriosis are high for most women.
The first step prior to treatment is to complete a full infertility work-up to identify any other potential challenges such as age or male fertility issues that the couple may experience when trying to conceive. A fertility specialist can help you rule out other health issues and determine which treatment options are best for you, depending on the severity of your endometriosis and if any other factors are present that may make trying to conceive more difficult. As women age, treatment options tend to narrow—even if your endometriosis is mild—so we suggest seeking help sooner rather than later.
If you have already been diagnosed with endometriosis, patients with pain from endometriosis who are trying to conceive can sometimes feel like they are in a catch 22. They have to stop the hormonal medication that is providing them with pain relief, but then they feel an additional sense of urgency—not to mention discomfort—if they don’t conceive in a given month. For patients with pain from endometriosis, they might consider having surgery to alleviate the pain, which can buy a window of time in which they can hopefully conceive. Seeking consultation with a fertility specialist prior to such a decision can be helpful to maximize the chances of pregnancy after surgery. After surgery, we may decide to pursue fertility treatment to expedite pregnancy, with either medications like clomiphene citrate (Clomid or Serophene) with an intrauterine insemination (IUI) or even in vitro fertilization (IVF). The good news is that once a woman is pregnant, her pain from her endometriosis usually subsides during the pregnancy itself.
I’ve already had surgery for endometriosis, should I have more surgery?
While surgery can be helpful in alleviating pain, we have to be careful not to continue to operate every time a cyst develops, because with each excision to the ovary, we are also losing healthy eggs. Also, additional surgery does not increase the chances of pregnancy after IVF.
I have no pain, and I’m trying to get pregnant.
The puzzling part of endometriosis is that the degree of disease does not always correlate with the degree of pain that a patient experiences. Some women only have infertility as a consequence of endometriosis, and do not have any pain at all. For these women, the benefit of surgery is less clear, but fertility treatment can be very helpful. This could be either medication to stimulate the ovaries combined with an IUI or IVF.
For more information about getting pregnant with endometriosis, or for more information about egg freezing to help preserve your family-building options for the future, please speak with one of our New Patient Liaisons at 1-877-971-7755 or click to schedule an appointment.