What You Need to Know About Fertility and Endometriosis (When You’re Not Ready to Have Kids!)

There’s no feeling like finding out you might be infertile. Even though I don’t want to have kids for a long time, finding out that my endo could affect my fertility was rough.

As much as half of women with endometriosis experience trouble getting pregnant. For the longest time, I didn’t want kids until I was 30. Now, I have to think about having kids while I’m still in my 20s, while my fertility is at its peak. While it might not seem like there’s a huge difference between having kids at 27 and having kids at 30, it sucks when such a major life decision feels like it’s out of your hands.

At the end of the day, there’s only so much you can do to optimize your fertility. So much depends on your endo: what stage it’s in, how successfully your doctors can remove it, how much scar tissue develops…. the list goes on and on.

Most twenty-somethings probably don’t think much about their fertility (most of us are just out here trying not to get pregnant, thank you very much). Unfortunately, when you have a disease that impacts your ability to get pregnant, you’re forced to confront your fertility a lot earlier than you might want to.

So, what do you need to know about fertility and endometriosis — especially as a young twenty-something who doesn’t want to have kids yet? Here’s everything you need to make informed decisions about your fertility in your 20s, before you’re ready to have kids.

Fertility in Your 20s

Unsurprisingly, your chances of getting pregnant are highest in your 20s: 20-25% per month. (By age 40, they decline to 5% per month.) This makes sense, considering that a long time ago, this was the peak time for women to have children.

Nowadays, however, more and more women are choosing to wait to focus on their careers — and right on! The consequence is that more and more women are having babies in their 30s and 40s, increasing the risk of pregnancy complications and medical conditions in the baby.

If you do choose to get pregnant in your 20s, you may have the highest success in IVF: the success rate for IVF is 41-43% in patients under 35. That doesn’t mean that IVF won’t work when you’re older, but you have the best odds in your 20s.

How Endometriosis Impacts Fertility

Up to 30-50% of women with endometriosis experience infertility due to scarring. Hence, the more severe the endometriosis, the more likely you are to experience difficulty getting pregnant.

If you have a diagnostic laparoscopy for endo, your doctor will likely “stage” your endometriosis based on the amount, depth and location of the implants. Stages I and II are less severe, and may not cause as much difficulty as Stages III and IV, which produce extensive scarring of the uterus and ovaries and can even result in a frozen pelvis.

That doesn’t mean that endometriosis is a death sentence for your fertility, though. Even among women with Stage III and Stage IV endo, 75% of women who want to become pregnant do — 2/3 naturally and 1/3 with the help of IVF.

Women with endometriosis may also take hormones, like oral contraceptives or progesterone, to control their periods. These hormones prevent pregnancy, and should be stopped under the direction of your doctor when trying to conceive. They may prevent you from getting pregnant as quickly as you like, since it can take 1-3 months for fertility to return. However, half of women get pregnant within three months of stopping hormones, and most women get pregnant within a year.

So, Do You Need to Freeze Your Eggs?

When I was reading the book Beating Endo, I nearly dropped it when one of the authors said she recommended her patients freeze their eggs before undergoing laparoscopy for endometriosis. I immediately freaked out: was this something I needed to consider?

Halsey did. She recently came out as having endometriosis and stated that she’d decided to freeze her eggs for the highest chance of pregnancy as she ages. Many experts also recommend freezing your eggs when you have endometriosis, before the disease progresses to stage III or IV. But that doesn’t mean you have to do the same.

Your odds of pregnancy with endo may be lower, but that doesn’t mean that they are nonexistent, or even that you should worry. According to Dr. Tamer Seckin, author of The Doctor Will See You Now and renowned endometriosis surgeon, as many as 70% of his endo patients go on to conceive successfully.

Especially if you have excision surgery (and don’t have deep invasive endometriosis), you may not struggle to conceive at all. The higher the stage of endo, the harder it may be to get pregnant when the time comes — so if you have stage I or stage II endometriosis, you likely don’t need to worry about freezing your eggs in your 20s.

Granted, endo is progressive — and surgery can only do so much — so there’s some logic to freezing eggs in the early stages of the disease. However, freezing your eggs is expensive (retrieval alone can cost thousands of dollars, and you may pay up to $1.5k per month to store them) and may not be necessary if you have well-managed endometriosis.

What You Can Do for Your Fertility NOW

I know, I know: fertility is the last thing you want to think about in your 20s. Now is the time to be dancing on tables and building a personal brand! But if having kids is a priority in your life, you need to optimize your health to be able to conceive when the time comes — especially if you struggle with endometriosis. Here’s what you can do right NOW to help your fertility:

  • Track your period and get to know your “normal.” Take note if your cycles are longer than 35 days, since this can be a signal you may not be ovulating normally.
  • Prevent STIs by always using a barrier method (like a condom or dental dam) when you have sex of any kind. Untreated STIs can lead to Pelvic Inflammatory Disease, which may cause scarring that can impact your fertility in the future.
  • Take a multivitamin containing folate. You should start taking folate long before you want to become pregnant — and since more than half of all pregnancies in the U.S. are unplanned, it’s never too early to start.
  • Keep watch of toxic chemicals in your life, which can cause birth defects. Avoid BPA by going plastic-free whenever possible, and go organic to minimize your exposure to pesticides.

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