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Endometriosis (whether assumed or confirmed) can bring a lot of stress, pain, and uncertainty into your life. Once you kick off your path toward pregnancy, you may even start wondering if getting pregnant while living with endometriosis is a possibility.
The answer to this question has layers, according to Dr. Jessica Ryniec, a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.
“Many people are able to get pregnant with endometriosis without fertility treatment, but many do need assistance (meaning IVF), and it's better to know that as soon as possible,” explains Dr. Ryniec.
While the information overload may feel like a lot at first, it can be beneficial in the long run to better understand whether you have endometriosis and whether it can impact your chances of getting pregnant.
How to figure out if you have endometriosis
First, a very important fact. On average, it takes 7-10 years to get diagnosed with endometriosis. This is due to many reasons, but the most common is that it is often missed as a cause for pelvic pain or infertility, or dismissed by doctors or women themselves. For instance, painful periods are a clear symptom but are often ignored as just part of being a woman.
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Suspecting endometriosis is the first step. Know the symptoms. Once suspected, there are many ways to get closer to an endometriosis diagnosis. You can find a care team that listens to your gut instincts about your body and uses their knowledge to confirm a diagnosis for you. The most definitive diagnosis is through a surgery known as a laparoscopy, where doctors will be able to spot any endometriosis on your organs (since ultrasounds can’t pick up all endometriosis).
The downside to going right to surgery is it’s invasive and expensive. You can also turn to a test like Receptiva DX, which looks for a protein marker (BCL6) that “identifies uterine lining inflammation most often associated with endometriosis including asymptomatic (silent) endometriosis,” per the test’s website. Testing positive for BCL6 highly suggests an association with endometriosis (93% sensitive). The test is designed for women who can’t get pregnant naturally, have recurrent miscarriages, or have gone through IVF and failed.
Dr. Ryniec adds: “The ReceptivaDx test is a way of screening for altered immune function (inflammation) at the lining of the uterus that can be caused by endometriosis. It can't definitively help detect endometriosis but is a tool to screen for it as a possibility. It is less beneficial if someone has obvious signs [or] symptoms of endometriosis, but can be very helpful for those with a diagnosis of unexplained infertility or IVF implantation failure that may be attributed to endometriosis.”
The more information you gather about your potential or confirmed endometriosis diagnosis, the more you can confidently map out your TTC next steps. As Dr. Ryniec explains, those who live with endometriosis can get pregnant both with or without assisted reproductive technology (ART); it’s a matter of finding what works best for them.
What to know about trying to conceive with endometriosis
Once you know that endometriosis is at the root of your trying to conceive journey, it can be helpful to understand how exactly endometriosis may impact your journey towards pregnancy so you can reverse engineer the best care plan for you.
According to Dr. Ryniec, there are many different ways that endometriosis can impact a person’s fertility, and anywhere from 30-50% of people with endometriosis will experience infertility.
“The first is through altered anatomy,” explains Dr. Ryniec. “Endometriosis can cause scar tissue which can impact the way the uterus, fallopian tubes, and ovaries are positioned, can block or damage the fallopian tubes, or can block the path between the tubes and ovaries making it difficult for an egg to get picked up. Second is that endometriosis is highly inflammatory and can lead to altered immune function in the pelvis that can impact implantation. Third, it can alter the hormonal environment around the ovary, which can lead to decreased egg quality. Finally, pain from endometriosis can lead to sexual dysfunction.”
After you decide that trying to conceive is your goal, and there is a suspicion of endometriosis, Dr. Ryniec recommends finding a care team that supports you through your journey to pregnancy, whether naturally or through ART and creates options to address the potential or confirmed endometriosis.
“Know when to reach out for help so you have all of the info available to make informed decisions about how you'd like to approach family building,” encourages Dr. Ryniec.
She adds: “The best advice is to try to manage endometriosis either with medical or even surgical treatments and to know when to seek a fertility doctor’s help. I often encourage people with a higher likelihood of infertility, including those with endometriosis, to consider evaluation even before they start trying to conceive or earlier in the process than it would otherwise be recommended to make sure they are optimizing their chances. This doesn't commit someone to fertility treatment but gives them the info they need sooner in the process.”
While trying to conceive with endometriosis doesn’t follow a one-size-fits-all care plan, this can actually be a good thing. You’re allowed to figure out what tests, procedures, and timelines work best for you and your body. Educate yourself and then go advocate for what you want!