How to get pregnant with endometriosis naturally: Tips and strategies
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Created with Hector Chapa, MD, FACOG, Clinical Assistant Professor of Obstetrics and Gynecology, USA
You can still get pregnant naturally with endometriosis when having regular sex. You can boost your chances of getting pregnant with endometriosis by eating healthy, staying active, managing stress, and tracking ovulation. After surgery, give your body time to heal and talk to your doctor to find the best plan for you.
If you have been recently diagnosed with endometriosis and doctors predict there might be some challenges with getting pregnant, you are not alone. According to the World Health Organization (WHO), endometriosis affects 10% (190 million) of both girls and women of reproductive age globally.
Even though the National Library of Medicine reports that 30-50% of women with endometriosis may experience infertility, there are tips for getting pregnant with endometriosis and answers.
What is endometriosis, and how does it affect fertility?
Simply put, endometriosis is a health condition that causes the uterine lining (endometrium) to grow outside the uterus. This endometrial tissue growth is usually associated with inflammation, pain, and scar tissue.
Symptoms of endometriosis
Endometriosis is often hard to diagnose, since symptoms vary. Some women may not notice it at all, while others may have severe pain. However, there are some key symptoms that doctors look for to diagnose endometriosis:
- Painful, heavy, or irregular periods;
- Pain in the lower abdomen, pelvis, or lower back, which may be worse around ovulation time;
- Pelvic pain that lasts over 6 months;
- Pain during or after sex;
- Pain when urinating (weeing) or pooping;
- Difficulty getting pregnant.
While each of these symptoms independently may signal many other health conditions, two or more symptoms from the list above often indicates endometriosis.
The exact reason why endometriosis affects fertility is unclear, though healthcare professionals agree that it may be more difficult to conceive if endometriosis is severe.
According to NCBI, women diagnosed with mild endometriosis have a lower probability of pregnancy over 3 years compared to women with unexplained infertility (36% vs. 55%, respectively). Further IVF studies found that women with more severe symptoms have poor ovarian reserve and low oocyte and embryo quality, which makes it harder for them to conceive.
What are the chances of getting pregnant with endometriosis?
Endometriosis does not always mean infertility, and natural conception is possible in any case of severity.
According to a 2014 review, women with endometriosis regularly having sex have a 2–10% chance of conceiving each month. The same source reports that those who don’t have the disease have 15–20% chance.
Femia offers the most accurate tool for determining ovulation and fertile days
How to improve your chances of pregnancy with endometriosis?
There are many simple strategies recommended to help manage the symptoms and severity of endometriosis, and following these tips may increase your chances of conceiving.
1. Consider diet changes: Even though diet alone won’t cure endometriosis, some changes may help manage symptoms and assist in getting pregnant. Food significantly affects hormone levels, weight, and inflammation—all factors which may negatively affect the severity of the disease. Try to include foods rich in antioxidants and omega-3 fatty acids, like fruits, vegetables, seeds, nuts, and fatty fish.
2. Engage in moderate physical activity: An NCBI study reported that regular physical activity can be a helpful measure in reducing endometriosis-related pain and inflammation. The reason is that our bodies release myokines—a group of cytokines including IL-6, irisin, and myostatin—when our muscles are working. These myokines contribute to anti-inflammatory, metabolic, and immunological processes.
While regular walks are sufficient for managing the disease’s symptoms, exercises like swimming, walking, and biking may help reduce estrogen levels, stress, and inflammation.
3. Manage stress levels: according to the National Institutes of Health (NIH), endometriosis is associated with high levels of chronic stress, which correlates with pain severity and disease extension.
Regular yoga practices (2-3 times a week), moderate physical activity to your liking, quality sleep (at least 8 hours a night), and spending more time in nature are highly effective strategies for managing stress levels and reducing pain.
4. Track your menstrual cycle: Monitoring your menstrual cycle greatly helps determine the best days for conception. You can consider using ovulation prediction kits and tracking body temperature to identify your fertility window.
It is also recommended to have sex every two to three days throughout the entire cycle. But, it is mostly important when you are most likely to ovulate.
What are peak fertility times?
Ovulation means a mature egg is released from the ovary and moves down the fallopian tube, where it can later be fertilized. If sperm is in the fallopian tube at that time, the chances of getting pregnant are higher compared to any other day of the cycle.
The most fertile days (also called a fertility window) are the three days leading up to and including ovulation. To identify the length of the menstrual cycle and fertility window, record the first day you start bleeding—this is counted as the 1st day of your cycle. The last day of the cycle is the day before the next period.
Ovulation usually happens about 14 days before starting your period.
- If your menstrual cycle is 25-28 days, you ovulate around days 12-14. Your fertility days are 10, 11, 12, 13, and 14, respectively.
- In the case of a shorter cycle, let’s say 19-21 days, ovulation will happen approximately on day 7, and your most fertile days will be 3, 4, 5, 6, and 7, respectively.
Those having irregular cycles may find it harder to identify fertility days, so tracking with apps and checking symptoms will always be a good idea. Some women experience breast pain, abdominal pain, and mood swings before and during ovulation, so this might be helpful in determining the fertility window with irregular cycles.
What is the best age to get pregnant with endometriosis?
While endometriosis may make it harder to conceive, age is a crucial factor in getting pregnant for all women – with or without a disease that affects fertility.
Female fertility peaks in the early 20s and starts to decline by the early 30s. This decline becomes more noticeable in the mid and late 30s and beyond the age 40.
While the late teens through early 20s is considered the “perfect” age to get pregnant, there are still chances of conceiving after that age.
Alongside fertility decline, some pregnancy risks also increase with age. An NCBI review reports that women over 30 may have higher chances of miscarriage, stillbirth, preterm birth, and several other mild pregnancy complications. However, the same source reveals that around 50% of females in different age groups with mild endometriosis and 25% with moderate endometriosis are getting pregnant without any treatment.
So, while a doctor may recommend getting pregnant as early as possible due to natural bodily factors and the highest chances of successful pregnancy, women over 30 and 40 with endometriosis can still get pregnant, even naturally.
Will surgery or having a laparoscopy increase your chances of falling pregnant?
The role of surgery in increasing the chances of conceiving in women with endometriosis is much debated. According to a 2013 study performed by NCBI, which compares laparoscopic surgical treatment of minimal and mild endometriosis with diagnostic laparoscopy only, laparoscopic surgery enhanced fertility rates, but the second group found no positive effect of surgery.
Another study reported that 63 of 87 participants diagnosed with endometriosis (72.41%) were able to fall pregnant. The same study also indicated that there wasn’t a significant difference between the groups half a year, one year, or two years after the surgery.
For women with superficial endometriosis, where the tissue attaches to the peritoneum, laparoscopic surgery may improve chances of conception. Ithas been shown to have positive effects on both pregnancy rates and chances of conceiving naturally. However, there has been little research on its effect on pregnancy rates in women with deep endometriosis (where the bowel, bladder, or ureter are involved).
Please note that consulting a healthcare professional is still a must when choosing the next steps of your pregnancy journey.
When to try getting pregnant after endometriosis surgery
As mentioned above, in the case of laparoscopic surgery, there were no changes between the groups at half a year, 1 year, or 2 years after the procedure. And, while age still plays a crucial factor in the chances of getting pregnant, there is no need to rush after surgery. When you can start trying to get pregnant after endometriosis surgery will depend on the specifics of your situation.
Let’s break down two different cases:
Case 1: If there was no work with the ovaries or the removal of fibroids from the uterine wall, you may want to try for a baby the next cycle.
Case 2: If the surgery removed endometriomas or fibroids, doctors usually recommend waiting at least 3 months to allow the ovaries and uterus to fully heal before conception is attempted.
In any case, prioritize healing before trying to conceive, and please consult a healthcare professional to get customized guidance, since surgery may differentially affect all bodies.
Questions from the Femia community
Does endometriosis cause problems with pregnancy?
Does endometriosis increase the likelihood of having a miscarriage?
Will I still experience endometriosis pain while I am pregnant?
What about breastfeeding?
The bottom line
Endometriosis affects up to 10% of women between 15 and 44. In some cases, the disease doesn’t have any symptoms and is only discovered when women try to get pregnant. In other cases, symptoms can be pretty rough.
Irrespective of symptoms and severity of the disease, the chances of getting pregnant with endometriosis when having regular sex are still pretty high, and there are many ways you can improve the odds. Working closely with your healthcare provider to find the best approach to your case, as well as making lifestyle changes, can help you manage endometriosis symptoms and increase your chances of conception.
References
- WHO. “Endometriosis.” World Health Organization, World Health Organization, 24 Mar. 2023, www.who.int/news-room/fact-sheets/detail/endometriosis.
- Petrozza, John. “Endometriosis and Its Impact on Fertility.” Massachusetts General Hospital, 26 Jan. 2023, www.massgeneral.org/obgyn/fertility/news/endometriosis-and-its-impact-on-fertility#:~:text=Endometriosis%20can%20make%20it%20more.
- Macer, Matthew Latham, and Hugh S. Taylor. “Endometriosis and Infertility.” Obstetrics and Gynecology Clinics of North America, vol. 39, no. 4, Dec. 2012, pp. 535–549, https://doi.org/10.1016/j.ogc.2012.10.002.
- Macer, Matthew Latham, and Hugh S. Taylor. “Endometriosis and Infertility.” Obstetrics and Gynecology Clinics of North America, vol. 39, no. 4, Dec. 2012, pp. 535–549, https://doi.org/10.1016/j.ogc.2012.10.002.
- Fadhlaoui, Anis, et al. “Endometriosis and Infertility: How and When to Treat?” Frontiers in Surgery, vol. 1, 2 July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4286960/, https://doi.org/10.3389/fsurg.2014.00024.
- Barnard, Neal D., et al. “Nutrition in the Prevention and Treatment of Endometriosis: A Review.” Frontiers in Nutrition, vol. 10, 17 Feb. 2023, https://doi.org/10.3389/fnut.2023.1089891.
- Kahr, Maike, et al. “Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control?” International Journal of Environmental Research and Public Health, vol. 20, no. 17, 26 Aug. 2023, pp. 6659–6659, https://doi.org/10.3390/ijerph20176659. Accessed 22 Sept. 2023.
- Kahr, Maike, et al. “Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control?” International Journal of Environmental Research and Public Health, vol. 20, no. 17, 26 Aug. 2023, pp. 6659–6659, https://doi.org/10.3390/ijerph20176659. Accessed 22 Sept. 2023.
- Reis, Fernando M., et al. “Is Stress a Cause or a Consequence of Endometriosis?” Reproductive Sciences, vol. 27, no. 1, Jan. 2020, pp. 39–45, https://doi.org/10.1007/s43032-019-00053-0.
- Ravins, Inbal, et al. “The Effect of Practicing “Endometriosis Yoga” on Stress and Quality of Life for Women with Endometriosis: AB Design Pilot Study.” Alternative Therapies in Health and Medicine, vol. 29, no. 3, 1 Apr. 2023, pp. 8–14, pubmed.ncbi.nlm.nih.gov/35839113/.
- Coccia, Maria Elisabetta, et al. “Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity.” International Journal of Environmental Research and Public Health, vol. 19, no. 10, 19 May 2022, p. 6162, https://doi.org/10.3390/ijerph19106162.
- Lee, Hye Jun, et al. “Natural Conception Rate Following Laparoscopic Surgery in Infertile Women with Endometriosis.” Clinical and Experimental Reproductive Medicine, vol. 40, no. 1, 1 Mar. 2013, pp. 29–32, www.ncbi.nlm.nih.gov/pmc/articles/PMC3630290/#:~:text=after%20the%20laparoscopy.-, https://doi.org/10.5653/cerm.2013.40.1.29.
- Zhang, Liyi, et al. “Pregnancy Outcomes in Patients with Tubal Infertility Following Laparoscopic Treatment: A Multivariate Predictive Study.” Annals of Palliative Medicine, vol. 10, no. 1, Jan. 2021, pp. 462–462, https://doi.org/10.21037/apm-20-2347. Accessed 11 Aug. 2022.
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