In some cases, endometriosis can cause fertility issues and make it harder to get pregnant. In vitro fertilization (IVF) can help in these cases.

Infertility refers to being unable to conceive after having regular sex without a barrier method or birth control for 1 year.

Although not everyone living with endometriosis experiences fertility issues or infertility, it is a relatively common complication of the condition.

IVF is a form of assisted reproductive technology. It involves removing an oocyte (egg) from the ovary, combining it with sperm outside of the body to create an embryo, and then placing that embryo into the uterus.

IVF is one way for a person with endometriosis-related infertility to become pregnant. Many people have successful pregnancies through this process.

Read on to learn more about how IVF can help individuals with endometriosis become pregnant, success rates, and potential complications of this process.

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Endometriosis can impair fertility in several ways.

Endometriosis can cause anatomic distortions and scarring, which can block fallopian tubes and prevent the eggs from combining with sperm.

It can cause inflammation, which can cause pain and bleeding, and can also reduce egg quality. It may be associated with implantation failure and an increased risk of miscarriage.

IVF can help people experiencing endometriosis-related infertility, especially if endometriosis is causing anatomic problems, such as blocked fallopian tubes.

Research has looked into the most beneficial approaches to IVF. Experts have found certain strategies and protocols may be better for people with endometriosis. Fertility doctors can personalize a treatment plan to fit a person’s unique situation.

In some instances, a doctor may consider medical therapy or surgery before starting fertility treatment to increase the chance of becoming pregnant.

A doctor may diagnose infertility if a person does not become pregnant after having regular, unprotected sex for 1 year if they are under age 35 or for 6 months if they are over age 35.

However, a doctor may consider treating infertility earlier in cases where the person has endometriosis.

Fertility declines with age due to a natural reduction in egg quality and quantity. Therefore, success rates of becoming pregnant through IVF are higher for younger people.

However, when to become pregnant is a personal decision. People who may want to delay getting pregnant but are concerned about their age and fertility can consider IVF to bank eggs or embryos. Banked eggs or embryos can be used later to help the person get pregnant.

Before starting IVF or fertility treatment, a fertility doctor runs several tests, including ovarian reserve tests.

Ovarian reserve tests help a doctor estimate how many eggs a person has. If the ovarian reserve is low, the person may consider using donor eggs to conceive.

Before IVF treatment begins, a person goes through several evaluations to ensure they understand the process and are a suitable candidate.

A doctor also assesses the number and quality of eggs in the ovaries. If the number or quality of eggs is low, they may consider using donor eggs.

The IVF process comprises several key steps:

  1. Ovarian hyperstimulation: The person takes fertility medications, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These medications stimulate the ovaries to produce more eggs for collection and fertilization.
  2. Egg retrieval: While the person is under general anesthesia, a fertility doctor uses an ultrasound to guide the insertion of a long, thin needle inside the vagina, through the vaginal wall, and into the follicles in the ovaries. A suction device is attached to the needle, which helps retrieve the eggs from the follicles.
  3. Insemination and fertilization: The retrieved eggs are prepared for fertilization. The eggs are either placed with sperm with the aim that the sperm will enter the egg and fertilize it, or the fertility doctor injects sperm directly into the egg. The latter is a procedure called intracytoplasmic sperm injection.
  4. Embryo culture: The fertilized egg begins to divide and grow over 5–7 days. The embryo progresses until it reaches the blastocyst stage, at which point a person can choose to do preimplantation genetic testing of the embryo. It screens the embryo to make sure it has a normal number of chromosomes.
  5. Embryo transfer: Once the embryo is at the blastocyst stage, a doctor can transfer the embryo into the uterus. Embryos may be transferred fresh (without being frozen) or during a frozen embryo transfer cycle. The number of embryos to transfer depends on several factors. Most commonly, a single embryo is transferred.

Pregnancy begins at implantation, when the embryo attaches to the uterine lining.

Studies on IVF outcomes in people with endometriosis are mixed.

Some studies show no difference in outcome in people with endometriosis. Other studies show people with endometriosis-related infertility have lower pregnancy rates than those with other infertility diagnoses.

Results of a 2021 study with 330 participants found that treatment for endometriosis affects IVF success rates.

Participants with untreated endometriosis had a live birth rate of 27.7%, compared with a live birth rate of 43.6% for people with endometriosis in early stages of treatment and 46.3% for people with endometriosis in later stages of treatment.

Overall, researchers have not reached a consensus on how endometriosis affects IVF success rates.

The severity and stage of endometriosis can also affect the success of IVF. For example, according to a 2012 study, deeply infiltrative endometriosis significantly lowers the success rate for IVF than superficial endometriosis.

More studies are needed to determine the true effects of endometriosis on fertility and IVF outcomes.

Some people say going through the IVF process can exacerbate their endometriosis symptoms.

Because estrogen is the hormone mostly responsible for the growth and spread of endometriosis, it is possible that increased levels of estrogen due to medications used in IVF may worsen the condition.

However, according to a 2020 review of previous studies, people with endometriosis do not have a risk of disease reoccurrence due to IVF.

A doctor can provide guidance and information about going through IVF with endometriosis.

Questions to consider asking a fertility doctor include:

  • How long should I try to conceive before considering IVF?
  • How effective is IVF for someone with endometriosis?
  • How does my endometriosis affect the IVF process?
  • What happens if IVF doesn’t work on the first attempt?
  • How many times can I try IVF? How much will it cost?
  • How can IVF affect my endometriosis symptoms?

Endometriosis can affect fertility in several ways.

For people with endometriosis-related infertility, IVF is an option worth considering to help them conceive.

If a person is having difficulty getting pregnant and thinks they may have endometriosis, they can speak with a fertility doctor. The doctor can perform testing to better understand the person’s fertility status and suggest a treatment plan.