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How Does Endometriosis Impact Fertility?

If you have endometriosis, you might have a host of concerns ranging from how to quell the notoriously agonizing pain to how this condition may impact your fertility. Though estimates vary, some figures suggest that between 30 and 50 percent of people with endometriosis have impaired fertility, according to the Mayo Clinic. But what does that actually mean for you if you’re dealing with this condition?

What is endometriosis?

Endometriosis is commonly thought to happen when the inner lining of the uterus grows on other organs. According to the Merck Manual, endometriosis lesions can show up on organs including the ovaries, fallopian tubes, outer surfaces of the uterus, vagina, rectum, or even far-flung places like the lungs and heart (in very rare cases). This tissue can bleed and cause symptoms like incredibly painful periods.

Doctors aren’t entirely clear on why these growths crop up where they shouldn’t. According to the Mayo Clinic, one possible cause of endometriosis is retrograde menstruation, which is when period blood flows backward into the body rather than out of the vagina. Another factor may be that an immune system issue in people with endometriosis prevents their bodies from destroying endometrial tissue outside of the uterus, the Mayo Clinic explains.

A different theory holds that the wayward tissue of endometriosis is similar to the lining of the uterus but can actually produce its own estrogen, causing painful inflammation, as SELF previously reported.

Wherever this misplaced tissue comes from, it’s clear that it can impact fertility in some people with endometriosis.

Endometriosis doesn’t always make it hard to conceive.

Before we explore the mechanisms by which endometriosis may affect fertility, we want to be clear: Trying to get pregnant when you have endometriosis is absolutely not a hopeless caus

e. “Women with endometriosis can get pregnant and do all the time,” Karli Goldstein, D.O., associate surgeon and fellow of endometriosis surgery at Seckin Endometriosis Center, tells SELF.

You may not need any kind of fertility treatment at all, even with endometriosis. According to the Mayo Clinic, people with mild to moderate endometriosis, especially those who are younger, may be able to get pregnant without intervention.

However, endometriosis can affect fertility in a few ways.

Doctors are still investigating exactly how endometriosis can affect fertility. There appear to be several ways that endometriosis can throw a wrench into the process.

The added difficulty is largely because conceiving requires a chain of complicated events to take place successfully. “For pregnancy to occur, a long series of perfect steps has to happen,” Dr. Goldstein says.

You may remember this from sex ed: An egg has to meet with sperm at the right time in the menstrual cycle, they have to be of good enough quality in order for fertilization to take place, then the fertilized egg must be able to move down a fallopian tube to implant in the uterus. All of this happens before you even get a plus sign on a pregnancy test.

Endometriomas are one possible obstacle in this process. These benign ovarian growths that happen due to endometriosis are sometimes called “chocolate cysts” because of the old blood that makes up their thick, tar-like contents. These cysts can “invade the healthy ovary and destroy the eggs that are resting there,” Zev Williams, M.D., chief of reproductive endocrinology and infertility at New York-Presbyterian/Columbia University Irving Medical Center, tells SELF. Endometriosis-induced cysts can also adhere to the fallopian tubes, possibly making it difficult for a fertilized egg to travel to the uterus to receive nourishment.