From our Dallas IVF patients to Hollywood stars, “Can endometriosis cause miscarriage?” is on a lot of minds

Celebrities are opening up about the debilitating effects of endometriosis and its possible effect on miscarriage and infertility. Amy Schumer, Tiffany Haddish, Padma Lakshmi, Olivia Culpo and many others have expressed their pain and frustration with this condition whose cause is still not well understood.

A link between endometriosis and miscarriage is also a concern regularly expressed by our patients. Following is my answer and advice for those concerned (in Hollywood, Dallas or anywhere).

According to the United States Office on Women’s Health, approximately 11% of women aged 15 to 44 have endometriosis (when cells like those lining a woman’s uterus grow abnormally outside of the uterus, often causing pain and other troubles). The disease often goes undetected or misdiagnosed because the severe pelvic pain it causes is frequently mistaken for menstrual cramps. Often, there are no symptoms of endometriosis at all.

On average, women in the United States will suffer from endometriosis for 10 years before receiving a proper diagnosis. Upon finally getting a correct diagnosis, actress Emma Roberts said, “All of a sudden, there was a new world of conversation about endometriosis, infertility, miscarriages … I was so grateful to find out I was not alone in this.”

What is the link between endometriosis and miscarriage?

While reasonable evidence exists to show an association (though no causal connection) between endometriosis and infertility, according to the American Society for Reproductive Medicine, there is even less data available on the link between endometriosis and miscarriage. From my clinical experience and reviewing studies, women with endometriosis are at a greater risk of miscarriage, if only slightly greater, than those who do not have the condition.

One study that followed nearly 30,000 Danish women for four decades up to 2017 found that those with endometriosis were less likely to get pregnant, more likely to experience miscarriage, and their chances of losing a baby for each subsequent pregnancy increased.

Another study, from the European Society of Human Reproduction and Embryology (ESHRE), found that, after adjusting for age and previous pregnancies, Scottish women with endometriosis had a 76% higher risk for miscarriage and nearly three-times higher risk for ectopic pregnancy (when an embryo implants somewhere other than the uterine lining).

The truth is, not all people with endometriosis will experience miscarriages and many go on to have successful pregnancies. With appropriate diagnosis, treatment and medical care, we can minimize the risk of miscarriage from endometriosis.

How can endometriosis cause miscarriage?

Inflammation may play a role in increasing the risk of miscarriage in those with endometriosis. Other factors may be changes in the immune system and problems with embryo implantation in the uterus. The severity of a woman’s endometriosis may also influence pregnancy loss.

The researchers in the ESHRE study posit that endometriosis can alter the shape of the uterus, making it difficult for an embryo to develop normally. Scar tissue may block the natural course of a fertilized egg and result in an ectopic pregnancy.

It’s important to note that most available studies on the topic have reached conflicting conclusions. Epidemiological studies suggest that women who have endometriosis have greater obstetrical risks in general, compared with the general population, including preterm births and small-for-gestational-age births.

How to prevent miscarriage with endometriosis treatment

There is no cure for endometriosis, and there’s usually not any treatment for a miscarriage it may cause. But we do have treatments for recurrent pregnancy loss that may be caused by endo. However, a fertility specialist can treat the symptoms and resulting infertility the condition may cause using medications, hormone therapies, surgery and infertility treatments, such as in vitro fertilization (IVF).

Get a proper endometriosis diagnosis

Because so many symptoms of endometriosis mimic more common (and less critical) conditions, it is important to be seen by a medical specialist. If you have experienced one or several of the following symptoms for a long time, and particularly if you are considering getting pregnant, I encourage you to make an appointment with Dallas IVF.

• Pain in lower abdomen before and during periods that is worse than normal menstrual cramps.
• Pain during or after sexual activity.
• Painful urination/bowel movements during periods.
• Heavy bleeding.
• Gastrointestinal upsets, such as diarrhea, constipation or nausea.
• Inability to conceive after six months of trying naturally.

A proper endometriosis diagnosis can only be obtained through a surgical procedure called laparoscopy done under anesthesia. Results will show the location, size and extent of any tissue growths.

Consult a fertility specialist about assisted reproductive technology

If you are diagnosed with endometriosis and are interested in getting pregnant, assisted reproductive technology (IVF and egg donation for example) may likely be your best option. One of our fertility doctors can help assess whether the presence of endometriosis might contribute to a miscarriage and offer advice on how to minimize pregnancy loss.

Treatment options may be combined to give the best chance for pregnancy success. Medications such as gonadotropin-releasing hormone can be used to suppress ovulation and reduce inflammation, which may help to improve fertility and reduce the risk of miscarriage. Some emerging research has explored the potential benefits of immunomodulatory therapies to balance immune responses that might impact implantation and pregnancy.

Prepare for constant monitoring

Because women with endometriosis face higher risks of miscarriage and ectopic pregnancy in the first trimester, their fertility specialist may increase the amount of monitoring during the first three months, especially. Be prepared to undergo extra ultrasound scans and pay attention to potential complications, such as bleeding or preterm delivery.