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Your uterus creates extra tissue each month to create a cushy home for your potential baby. But if you have endometriosis, your uterine tissue grows wild, and can end up in places you don’t want it to be—including places where it could cause some serious fertility issues. In fact, a recent Journal of Assisted Reproduction and Genetics study estimated endometriosis is to blame for between 25% to 50% of all infertility cases. 

What is endometriosis?

Endometriosis develops when your body grows uterine lining (a tissue called endometrium) in places where it doesn’t belong. Most often, it shows up in areas near your uterus—your fallopian tubes and ovaries, on the outside of the uterus, in the vagina or cervix. In a few rare cases, it can even end up in other places, like your bladder. 

It may feel like you’re the only person in the world dealing with these symptoms, but the truth is, it’s just that people don’t talk about their symptoms. Endometriosis is extremely common. According to the Office on Women’s Health, more than 11% of women between the ages of 15 and 44 have developed it. Of those women, 30% to 50% experience some form of endometriosis infertility challenges. This is most common in women who: 

  • Are in their 30s and 40s, especially those with family members who have had it 
  • Started their period at a younger age
  • Have never had children
  • Have extremely long or short menstrual cycles

Signs of endometriosis

The most common red flag that you might have endo is severe cramping and pain, especially during your period. Here are some of the other telltale signs that you’re growing uterine tissue in odd places:

  • Pelvic pain: Women with endometriosis often develop chronic severe back and pelvic pain. They may also experience severe menstrual cramps, pain when they pee, and even painful sex (which will definitely be a fertility hurdle). 
  • Digestive upset: Stomach cramping, diarrhea, constipation and bloating occasionally accompany endometriosis, especially if you have your period. 
  • Heavy periods—and spotting in between them: Women with endometriosis may bleed outside their typical menstrual cycle, or develop heavy bleeding when they have their period. Fun times! 
  • Infertility: Scarring and excess tissue can literally cause a roadblock that can keep eggs and sperm from meeting, or even prevent a fertilized egg from implanting in the uterus.

How endometriosis can affect fertility

In case its other symptoms didn’t suck enough, endometriosis can also cause infertility, thanks to the scarring and excess tissue buildup. Ironically, all that uterine tissue that your body is producing for a baby could actually block the pathways to conception. 

“Endometriosis is thought to cause infertility because of the scarring and adhesions that result when endometrium grows on pelvic organs,” says Dr. Nataki Douglas, M.D., Ph.D, director of translational research for the Department of Obstetrics, Gynecology and Women’s Health at Rutgers University in New Jersey. The more extensive the disease and scarring, the greater the negative impact on fertility. “For instance, the adhesions can make it more difficult for an egg to be swept up by a fallopian tube and become fertilized.”

Can and should I freeze my eggs if I have endometriosis?

Absolutely. Some doctors will recommend egg freezing for women with endometriosis, while they're young and the condition is still in the early stages. Because some surgeries for endometriosis can actually worsen fertility by inadvertently removing healthy ovarian tissue or compromising vascular supply to the ovary, egg freezing should be done before any such surgeries.

If you are interested in freezing your eggs, we can connect you with a fertility specialist for a consultation to discuss your specific situation. Our Freeze by Co is making egg freezing more empowering, positive, and accessible — even free — when you give half of the eggs retrieved to a family who can’t otherwise conceive. 

What your doctor might recommend

The good news is, endometriosis can often be treatable. Depending on your situation, treatment might include:

  • Hormone therapy: Often in the form of birth control pills, this prevents additional tissue growth and damage. 
  • Pain relievers: Over-the-counter pain relievers can help manage the pain that comes with endometriosis at certain points in your cycle.
  • A diagnostic workup: Thankfully, some women with endometriosis are still able to conceive, but talk to a reproductive endocrinologist if you don’t get a positive pregnancy test on your own within 6 to 12 months. A full diagnostic workup might be a good idea. Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, TX, notes that this workup would likely include both diagnostic procedures for endometriosis and a hysterosalpingogram (HSG), which will show if your tubes are blocked. This may prevent pregnancy or increase the risk of an ectopic pregnancy, so you’ll want to work with your doctor on figuring out the best course of action.  
  • Surgery: This is one of the most effective methods for treating endometriosis and preserving fertility, according to Dr. Douglas, but also the most invasive. These surgeries can remove adhesions and ovarian cysts, clearing tissue out of the fallopian tubes and making pregnancy a real possibility. 

Still, you might need a little boost to make that baby happen. While there are tons of treatments out there, depending on a host of factors—age, number of years trying, status of fallopian tubes, status of sperm—women can proceed with standard fertility treatments, like oral medication and IUI. However, while it is the most invasive, “IVF has the best results in the majority of women with endometriosis,” says Daniel Kort, associate medical director and practice director at Neway Fertility in New York City. 

Bottom line

Endometriosis can be a real pain—literally and figuratively—and infertility is one of the most common complications associated with it. Fortunately, with a little help from a reproductive endocrinologist, it’s still possible to conceive if you’ve developed endometriosis infertility.