If you’ve been pregnant once, getting pregnant the second time should be easy, right? Well, not always. About 11% of couples experience secondary infertility, and one of the most common reasons is undiagnosed endometriosis. This is why it’s possible to have a successful pregnancy with endometriosis and then have difficulty getting or staying pregnant in the future. 

To help us understand this further, we spoke to a fertility specialist to answer all of your questions about endometriosis after pregnancy. 

default alt text

But first, what is endometriosis?

Endometriosis is a disease where tissue similar to the lining of the uterus is found elsewhere in the body — typically in the pelvic region. This tissue creates inflammation and lesions that can make it particularly challenging for an embryo to implant and attach to the lining of the uterus, thus leading to infertility in 30-50% of cases

There’s a lot to unpack when it comes to this condition that can affect up to 10% of women in general and a higher percentage of women seeking IVF. For women in their childbearing years, it takes, on average, 7-10 years to diagnose. Part of the reason is that symptoms such as pelvic pain mimic other conditions, but another reason is that many women are asymptomatic, also known as “silent” endometriosis. 

Research has found that between 20 and 25% of cases of endometriosis are considered silent endometriosis, meaning the person doesn’t experience any major symptoms other than not being able to get pregnant. 

How is endometriosis diagnosed?

Many cases of endometriosis are diagnosed before someone gets pregnant, in their teens or early twenties, often because they’re experiencing painful periods or pain with sex. But for others, it manifests in the form of unexplained infertility, recurrent pregnancy loss, or IVF failure. 

Surgical laparoscopy diagnosis can address the issue by removing lesions in and around the endometrium. However, it does not guarantee a permanent solution. More often than not, endometriosis returns, and whether you are attempting to get pregnant for the first time, second, or third, the longer the time from treating the endometriosis, the more likely you will have it again with potential infertility consequences. 

default alt text

Secondary infertility and endometriosis: What’s the connection?

According to Jessica Ryniec, MD, a Boston-based double board-certified OB/GYN and reproductive endocrinologist & infertility specialist, it’s not totally out of the ordinary to get a diagnosis of endometriosis after you’ve already given birth. 

“This could be that someone had previously asymptomatic endo that became symptomatic over time, or it could potentially be newly developed endometriosis as well,” explains Dr. Ryniec. You may not experience a huge change in symptoms if you’re diagnosed with endometriosis after pregnancy as opposed to before a pregnancy, she adds. It just might be that you’re experiencing infertility after your first pregnancy, and your endometriosis doesn’t come to light until then. 

How to know if you have “silent” endometriosis

If you suspect that endometriosis may be at play in your fertility journey, it’s important to work with your OB/GYN or infertility specialist to get to the bottom of the issue. While endometriosis can only be definitively diagnosed through laparoscopic surgery, another less-invasive option is the ReceptivaDx test, which looks for BCL6, a marker that identifies uterine lining inflammation most often associated with asymptomatic (silent) endometriosis. BCL6 is found in more than 50% of women with unexplained infertility and around 65% of women with two or more IVF failures. 

Treating endometriosis for fertility 

If you’re hoping to get pregnant and you test positive for markers of endometriosis, don’t worry; there are ways to treat its symptoms and improve your chances of a successful pregnancy, according to Dr. Ryniec. The first is laparoscopic surgery to remove the endometriosis, and the second is hormone suppression therapy for 60 days, which reduces the inflammation caused by endometriosis and provides a stable and viable surface for the embryo to grow. 

default alt text

The best news of all? Studies show that women testing positive for BCL6 and left untreated have just a 12% chance of a successful live birth, but once treated, the probability goes up to over 60%! 

Even if the ReceptivaDx test is negative, it still provides welcome assurance that uterine lining inflammation is not the primary cause of your infertility and improves the probability of a successful embryo transfer in the future. 

When it comes to endometriosis and fertility, knowledge is power, and if you’re dealing with secondary or unexplained infertility, know that there is hope for growing your family.

Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.