First of all it is necessary to establish a clarification of terms: is sterility and infertility the same? No! The first is defined as the inability to conceive, for example, for a year, and the second is more related to the inability to conceive. The causes for which one and the other occur? They are diverse, but some studies point to factors such as the pace of life, stress, pollution, eating habits or the age of the woman at the time of conception, something that is delayed until almost 40 years in many cultures.

Endometriosis and other diseases that cause some threat to pregnancy

  • There are some diseases called "enemies" that influence the conception process, in some cases, and in others the interruption of the pregnancy. What are those diseases?
  • Celiac disease, Gluten intolerance causes the appearance of antibodies that can be associated with a spontaneous abortion during the first trimester. For this reason, a timely diagnosis and some changes in guidelines at mealtimes can tackle this problem. And, as advice, the medical director recommends "preserving fertility since the risk of suffering early menopause or ovarian failure is very high. In this way, if the woman freezes her eggs to implant them in the future, the possibility of scares will be avoided when want to be a mother."
  • Thyroidism, A decrease in the level of thyroid hormones should be a reason for the endocrinologist to establish guidelines and a treatment based on levothyroxine sodium, the replacement hormone for the thyroid. As for food, adds the expert, "it is very important to use iodized salt so that the baby's thyroid can function properly and produce the hormones that she needs."
  • Endometriosis, although it can make it difficult to get pregnant and can lead to premature abortions, it is possible to have a good term with endometriosis, but your pregnancy will be classified by your gynecologist as risky, something that also happens with polycystic ovary syndrome.
## How these conditions interfere with conception: mechanisms, diagnosis, and practical examples As a practicing gynecologist I see the downstream effects of several chronic conditions that I call "enemies of pregnancy" because they either reduce the chance of conception or increase the risk of miscarriage and obstetric complications. Below I describe the mechanisms, what to look for clinically, and real examples from practice (anonymized and modified for teaching). ### Endometriosis — brief mechanism and diagnostic approach - Mechanisms: - Adhesions and distorted pelvic anatomy from endometriotic implants reduce tubal mobility and ovum pick-up. - Inflammatory cytokines in the pelvic environment impair sperm function, fertilization, and embryo implantation. - Endometriomas (ovarian cysts) reduce ovarian reserve locally and may damage follicles. - Diagnosis: - Clinical suspicion: cyclical pelvic pain, dysmenorrhea, deep dyspareunia, subfertility. - First-line imaging: transvaginal ultrasound (TVUS) to detect endometriomas and evaluate pelvic organs. - MRI: useful when deep infiltrating disease is suspected. - Definitive diagnosis: laparoscopy with visualization and histologic confirmation. However, many patients are managed on clinical/imaging grounds when surgery is not immediately indicated. - Real example: - Patient A, age 33, had 2 years of trying and severe dysmenorrhea. TVUS showed a 4 cm endometrioma on the left. AMH (anti-Müllerian hormone) was 1.2 ng/mL (low-normal). After counseling, she underwent laparoscopic cystectomy with careful ovarian tissue preservation, experienced improved pain, and conceived spontaneously 8 months later. This highlights that selective surgical treatment can restore function in chosen patients. ### Thyroid disease (Hypothyroidism and autoimmunity) - Mechanisms: - Maternal hypothyroidism impairs endometrial receptivity and early embryo development; TPO antibodies are independently associated with miscarriage. - Poorly controlled thyroid disease in pregnancy increases miscarriage risk and risks to fetal neurodevelopment. - Practical points: - Preconception TSH target is generally set lower than the nonpregnant range — many clinicians aim for TSH 3–4 cm), significant pelvic adhesions causing tubal distortion, or severe pain not controlled medically. - When surgery is performed for fertility, the aim is conservative laparoscopy: excision of endometriotic implants, adhesiolysis, and cystectomy for endometriomas with careful ovarian tissue preservation. - The risk: surgery can reduce ovarian reserve; the decision must balance symptom relief and fertility goals. - Assisted reproductive technology (ART): - IVF bypasses tubal factors and hostile pelvic environments; success rates depend mainly on ovarian reserve and age. - Timing: if ovarian reserve is reduced or age >35, consider earlier IVF referral. For severe endometriosis with poor anatomy, IVF may be first-line. - Practical example: - Patient F had bilateral endometriomas and severe adhesions seen on laparoscopy. She underwent adhesiolysis and was counseled that IVF would likely be needed; she pursued egg retrieval six months later and achieved pregnancy via IVF. ### Step 4 — Managing thyroid, celiac, and autoimmune disease in preconception and pregnancy - Thyroid: - If TSH abnormal, start/adjust levothyroxine. Recheck every 4–6 weeks after dose change, and target pregnancy-specific TSH goals. - Celiac disease: - Positive serology: confirm with gastroenterology and start a strict gluten-free diet before conception to reduce miscarriage risk and correct deficiencies (iron, folate, B12). - APS and thrombophilias: - For women with documented APS and prior pregnancy loss, management typically includes low-dose aspirin and low molecular weight heparin during pregnancy; coordination with a maternal-fetal medicine specialist is essential. - Practical example: - Patient G had previously undiagnosed celiac disease; after adopting a gluten-free diet and correcting iron deficiency, she had a successful second-trimester pregnancy. ### Step 5 — During pregnancy when an "enemy" condition is present - Endometriosis: - Pregnancy may reduce pain for many, but pelvic pain can persist; rare risks include ovarian cyst torsion from endometriomas — seek immediate care for sudden severe pain. - Increased surveillance: growth scans if there are concerns about placental function or fetal growth. - Autoimmune disease: - Close coordination with rheumatology/hematology for medication adjustments and thromboprophylaxis. - Thyroid disease: - Increase levothyroxine dose by approx. 20–30% in early pregnancy if already on replacement — individualize with TSH monitoring. - Practical tip: - Give women a written plan that includes emergency warnings (sudden abdominal pain, heavy bleeding, decreased fetal movements) and contact info for their high-risk team. ## When to refer and what to expect from specialty care - Refer to reproductive endocrinology (fertility clinic) when: - Woman is ≥35 and trying ≥6 months without pregnancy. - Known endometriosis with tubal disease or significant pelvic surgery and unsuccessful conception attempts. - Poor ovarian reserve (low AMH) — consider early referral for egg freezing or IVF. - Male factor abnormality on semen analysis. - Refer to maternal-fetal medicine (high-risk obstetrics) when: - Pregnancy achieved in a woman with moderate-severe endometriosis, APS, poorly controlled thyroid disease, or significant uterine anomalies. - What fertility clinics will do: - Cycle monitoring, ovulation induction, IUI (intrauterine insemination), IVF with controlled ovarian stimulation, and genetic testing of embryos if indicated. - Practical example: - Patient H, age 39 with low AMH, was referred promptly; she opted for one IVF cycle with PGT-A (embryo testing) and had a healthy singleton pregnancy after transfer. ## Practical advice I give patients in clinic — checklist you can use now - Start folic acid 400–800 mcg daily. - Stop smoking and recreational drugs; limit alcohol and caffeine. - Schedule preconception labs: TSH, AMH, CBC, fasting glucose, vitamin D, celiac serology if indicated. - Have your partner do a semen analysis early; don't leave male factor undiagnosed. - Use ovulation predictor kits and time intercourse during the fertile window for 3–6 cycles if there are no other red flags. - If you have chronic pelvic pain, cyclic symptoms, or prior pelvic surgery, book an appointment for pelvic imaging and specialist referral. - Consider egg freezing if you are >35 or have diminished ovarian reserve and are delaying pregnancy. For more background on specific fertility-supportive products and tracking tools I recommend, visit our [shop](/shop). For related deep-dive articles and practice resources, see our [related topic](/blog). ## FAQ ### What is the single most important thing I can do before trying to conceive? The most impactful single action is optimizing your health: start folic acid (400–800 mcg/day), stop smoking, normalize weight if significantly under- or overweight, and control chronic conditions (thyroid disease, diabetes, autoimmune disorders). These steps reduce miscarriage risk and improve the likelihood of a healthy pregnancy. Also, ensure your partner completes a semen analysis early — male factors are common and treatable. ### Can endometriosis prevent pregnancy completely, or can treatment restore fertility? Endometriosis does not always prevent pregnancy. Many women with mild-to-moderate disease conceive naturally or after minimal intervention. Treatment options depend on goals: if immediate pregnancy is desired, surgery to remove adhesions and endometriomas may help when anatomy is distorted, and IVF is often the best option for severe disease or when ovarian reserve is low. If pregnancy is not desired, medical therapies control symptoms but suppress fertility. Individualized counseling is essential — I often discuss ovarian reserve, lesion location, pain severity, age, and prior fertility history when making recommendations. ### I have celiac disease — do I need any special tests or treatment before pregnancy? Yes. Confirm current disease control with a gastroenterologist if not already in care. Before conception: - Ensure strict gluten-free diet adherence to reduce miscarriage risk. - Check and correct iron, folate, B12, vitamin D, and calcium levels. - Consider bone density assessment if long-standing untreated disease occurred. With proper nutritional repletion and diet control, outcomes improve significantly. ### How long should I try on my own before seeking fertility help if I have PCOS? If you have regular ovulation, try for 12 months if you are under 35. With PCOS and irregular cycles, start evaluation earlier. If you are 35 or older, seek evaluation after 6 months of trying. For PCOS, I often begin with lifestyle interventions and ovulation induction (letrozole) in primary care or family planning clinics, but if there is no response after 3–6 cycles, refer to a fertility specialist. ### Are there medications I must stop before trying to conceive? Yes — some medications are teratogenic or interfere with fertility. Common examples: - Methotrexate (used for autoimmune disease and ectopic pregnancy): stop months in advance and ensure disease control off the drug. - Isotretinoin (for acne): strict contraception and washout period are required due to high teratogenicity. - Warfarin is usually replaced with LMWH in pregnancy for women needing anticoagulation. - Certain antiepileptics require specialist input to balance maternal seizure control with fetal risk. Always consult your prescribing physician before stopping medications. For pain control, chronic NSAID use should be discussed because it can, in rare cases, inhibit ovulation. --- If you want a printable preconception checklist tailored to your medical history (endometriosis, thyroid disease, or others), book a consultation so I can prepare step-by-step management personalized to you. For evidence-based patient handouts and fertility-friendly products, see our [related topic](/blog) page and visit our [shop](/shop).