Is Pregnancy Possible After Endometrial Ablation?

As per statistics, the chances of getting pregnant after undergoing an endometrial ablation is less than 1%. If you want to get pregnant later, you should not consider endometrial ablation, as this procedure would make it harder for you to conceive. Women who undergo endometrial ablation are suggested to use birth control precautions after menopause. You may also consider ‘sterilisation’ as a further treatment for prevention of pregnancy after an ablation procedure.

Endometrial Ablation – What Is It and Why It Is Done?

The procedure of destroying a very thin layer of the uterus lining (endometrium) is known as endometrial ablation. Women experiencing heavy bleeding during their menstrual cycles are suggested to undergo an endometrial ablation in case oral medications don’t give relief or the cause of heavy bleeding is unknown. Endometrial ablation uses heat, cold or different types of energy to destroy the lining of the uterus, and the procedure is less dangerous and has fewer obstacles compared to a hysterectomy.

Most importantly, it is done on women who don’t plan to have children in the future.

What Are the Chances of Pregnancy Post Endometrial Ablation

Pregnancy is not likely after undergoing an endometrial ablation, but it can still happen with a high risk of complications during pregnancy. Many women have reportedly had a successful pregnancy after endometrial ablation, but they also come with a lot of risks associated with them. If you become pregnant after getting this procedure done, you are at high risk of suffering a miscarriage. Women who prefer to get pregnant later should never undergo this ablation procedure.

Another doubt many women tend to have is – ‘Can you get pregnant after an ablation and tubal litigation?’ Well yes, you can get pregnant after tubal litigation, as it is not a 100% guarantee of contraception. In this case, the chances are that you might suffer an ectopic pregnancy in which the eggs get attached to the fallopian tubes instead of the uterus.

Effects of Endometrial Ablation Procedure on Pregnancy

Endometrial ablation removes most of the endometrial tissue from the uterus. The lining left after the procedure is inadequate for the implantation of the foetus and its consequent nourishment needs. Due to this reason, a woman cannot conceive after she undergoes endometrial ablation.

Many studies reported ectopic pregnancy, termination, or miscarriage. Pregnancies that continued experienced high instances of preterm delivery, morbidly adherent placenta, spontaneous abortion, caesarean delivery, and caesarean hysterectomy. The reports also mentioned premature rupture of membranes, intrauterine growth restriction, intrauterine fetal demise, uterine rupture, and neonatal demise. However, in one 2017 study, the case reported successful pregnancy after microwave endometrial ablation.

Pregnancy Risks and Complications After Endometrial Ablation

Every procedure comes with a certain amount of risk associated with it. Women who undergo endometrial ablation should know the following risks and complications they might face during and after the procedure:

1. Risk of Perforations

The tool that the doctor uses for your ablation could puncture your uterus or harm nearby organs.

2. Foul Smelling Discharge

If you notice any bad odour from your vaginal discharge, you should immediately consult a doctor.

3. Fever

Some of the women who undergo endometrial ablation experience fever after the procedure.

4. Chills

Few women have also reported having chills after their ablation procedure.

5. Infection

This is a very common risk that is associated with an endometrial ablation procedure.

6. Heavy Bleeding

You may experience heavy to intense bleeding after this procedure. If you are not feeling well or experience giddiness, please reach out to your physician immediately.

7. Intense Cramping

Sometimes after undergoing an endometrial ablation procedure, some women have complained of excruciating stomach pains or cramping of the lower abdomen.

8. Continual Bleeding

A small percentage of women experience continuous bleeding lasting more than two days after the procedure.

9. Nausea

Some women have experienced nausea in the first few hours of the endometrial ablation procedure.

10. Trouble Passing Urine

There can be an urge to pee for the first 24 hours of the procedure.

11. Risk of Burns

There are various methods to perform endometrial ablation. In some of the procedures, there are chances of burn injuries to the vaginal areas and bowel.

12. Fluid Absorption in the Body

The fluid that is used in the expansion of your uterus during the process of electrosurgery might result in getting absorbed into your bloodstream. Though this happens in the rarest of rare cases, this can be a very dire condition. To prevent this from happening, the fluid used is carefully monitored throughout the procedure.

Things to Consider If You Get Pregnant After Endometrial Ablation

Although pregnancy after undergoing endometrial ablation is very rare, it does happen sometimes. These pregnancies have a certain amount of risk associated with them. That is the reason women undergoing endometrial ablation are advised to use reliable contraception after the procedure, and any unlikely pregnancy may have serious complications. If you are pregnant after undergoing the endometrial ablation procedure, you should consult your doctor to evaluate placental adherence and your subsequent delivery. Below are some facts that would provide you with insights into what things you should consider if you get pregnant after the ablation procedure:

1. Premature Delivery

The baby’s birth may take place more than three weeks before the baby’s estimated due date, often resulting in complicated medical problems.

2. Uterine Rupture

The endometrial ablation procedure raises the risk of uterine rupture or preterm premature rupture of membranes in pregnant women who have previously undergone the ablation procedure. This may result in compromising maternal and foetal life.

3. Caesarean Delivery and Caesarean Hysterectomy

You may have to undergo two simultaneous operations – first, the caesarean delivery and then the caesarean hysterectomy. The caesarean hysterectomy procedure involves the removal of the uterus at the time of caesarean delivery.

4. Perinatal Mortality

Preterm birth is the most common cause of perinatal mortality, leading to almost 30% of neonatal deaths.

5. Morbidly Adherent Placentation

In the rarest of rare cases, some of the pregnancies may result in morbidly adherent placentation in which the placenta grows too deeply into the uterus walls and is unable to detach during childbirth.

The endometrial ablation procedure is used for treating women who experience heavy and prolonged bleeding time during their menstrual cycle. The menstrual cycle either disappears completely or becomes lighter with this procedure. Women who want to conceive later in their life should not consider this procedure as this makes pregnancy very difficult. To reduce the chances of pregnancy, it is advisable to undergo a sterilisation process after endometrial ablation, along with using the usual birth control measures.

References/Resources:

1. Endometrial Ablation; Cleveland Clinic; https://my.clevelandclinic.org/health/treatments/21734-endometrial-ablation

2. Endometrial Ablation; Johns Hopkins Medicine; https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation

3. Ibiebele. I, Nippita. T. A, et al.; A study of pregnancy after endometrial ablation using linked population data; AOGS, Wiley Online Library – Obstetrics & Gynaecology; https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14002; September 2020

4. Kohn. J. R, Shamshirsaz. A. A, Popek. E, et al.; Pregnancy after endometrial ablation: a systematic review; BJOG, Wiley Online Library – Obstetrics & Gynaecology; https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.14854; January 2018

5. Endometrial Ablation; The American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/faqs/endometrial-ablation; Last updated: January 2022

6.  Alabi. C, Pickersgill. A; Successful pregnancy after microwave endometrial ablation: case report; Gynecological Surgery; Springer Open; https://gynecolsurg.springeropen.com/articles/10.1007/s10397-007-0343-0; September 2007

7. Bauer. A, Sheyn. D, et al.; 589: Incidence and outcomes of pregnancy after endometrial ablation in a multi-institutional cohort; AJOG; https://www.ajog.org/article/S0002-9378(16)31302-3/fulltext; January 2017

8. Foote. M, Rouse. A, Gil. K. M, et al.; Successful pregnancy following both endometrial ablation and uterine artery embolization; Fertility and Sterility, Volume 88, Issue 6, Pages 1676.e15-1676.e17; ScienceDirect; https://www.sciencedirect.com/science/article/pii/S0015028207002361; December 2007

9. Endometrial Ablation; Mayo Clinic; https://www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932

10. Xia. E, Li. C, et al.; The occurrence and outcome of 39 pregnancies after 1621 cases of transcervical resection of endometrium; Human Reproduction, Volume 21, Issue 12, Pages 3282–3286; Oxford Academic; https://academic.oup.com/humrep/article/21/12/3282/2939178; December 2006

11. Ansong. S, Glackin. K; Pregnancy after Endometrial Ablation : 3 cases; Queen’s University Belfast; https://www.qub.ac.uk/schools/mdbs/Study/ClinicalAcademicTraining/Filestore/Filetoupload,1000949,en.pdf

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