Endometrial ablation is a common procedure to treat heavy menstrual periods.
It is recommended pregnancy should be prevented after endometrial ablation. As a result, many women will also have a tubal ligation procedure or their partners will have a vasectomy. Some women will come to regret their treatments and will begin to investigate the possibilities of pregnancy after an endometrial ablation procedure.
We receive frequent inquires about pregnancy after ablation and we have dedicated a blog series to endometrial ablation and pregnancy.
We have authored two previous articles about pregnancy and endometrial ablation:
This article will explain the concerns and risks of pregnancy after an endometrial ablation procedure.
Pregnancy And Endometrial Ablation: Risks
Endometrial ablation removes the endometrial lining. This lining is, in part, responsible for heavy menstrual periods. The lining is also the nurturing environment for the early-fertilized egg. When the endometrial lining is removed it increases the risk of causing female infertility (never getting pregnant) and recurrent pregnancy miscarriage (early pregnancy loss).
Endometrial Ablation and Tubal Blockage: Infertility
Endometrial ablation can cause infertility through tubal blockage. During the healing response after an endometrial ablation procedure, adhesions (scar tissue) can form within the uterus.
Ablation, Ashermans, and Tubal Blockage
When the scar tissue is extensive and forms between the walls of the uterus this is called Asherman’s Syndrome. The scarring after an endometrial ablation can also cause tubal blockage in the intramural portion of the fallopian tube (the narrow portion of the tube which travels through the wall of the uterus). This scarring and tubal blockage can be a cause of infertility after ablation.
Endometrial Ablation and Miscarriage: Infertility
Early pregnancy miscarriage and infertility can be a result of endometrial ablation. The ablation procedure removes the pregnancy supportive endometrial lining. The uterine muscle, which can also be scarred, is what remains. The uterine muscle is not as receptive or supportive to the fertilized egg as is the uterine lining and many fertilized eggs will never attach- the end result is very early pregnancy miscarriage –or chemical pregnancies.
If the fertilized egg should attach to the uterine muscle after the protective uterine lining has been removed then this increases the chance the early placenta will invade and grow abnormally deep into the uterine muscle.
This could cause later pregnancy miscarriage or, more concerning, abnormal placental attachment.
Without the soft, protective uterine lining, the early placenta could grow deep into the muscle. This deep placental growth into the uterine muscle is abnormal and causes the placenta to be extremely adherent. When the placental tissue grows into the uterine muscle this is an abnormal condition termed a placenta accreta.
A placenta accreta is a high-risk pregnancy condition, which could cause abnormal blood supply for the baby, fetal growth restriction (small baby), and the placenta may not detach from the uterine muscle after birth. When the placenta does not detach this increases the risk of heavy post partum bleeding, blood transfusion, and emergent hysterectomy (removal of the uterus).
Pregnancy After Ablation: How does pregnancy happen?
The goal of endometrial ablation is to treat heavy menstrual periods. Uterine ablations are effective; however, many women will have their bleeding resume and some will need additional or alternative procedures to decrease their menstrual periods. The same reason most women will have recurrence of bleeding after endometrial ablation is the same reason why women can become pregnant after a endometrial ablation. The lining is not effectively removed and may also grow back.
Pregnancies occur after endometrial ablation because of one reason: most endometrial ablation procedures are not 100% effective at removing the entire endometrial lining. Some women will become pregnant after ablation when the fertilized egg finds a soft patch of endometrium.
Studies on Pregnancy After Endometrial Ablation
The tubal reversal experts of Chapel Hill Tubal Reversal Center are dedicated to providing more information on pregnancy alternatives after tubal ligaiton procedures. For our next article, Pregnancy After Endometrial Ablation: Study Review, we will review the most recent publications in the medical literature that describe pregnancy outcomes of women who became pregnant after an endometrial ablation procedure.