Can You Still Get Pregnant After Endometrial Ablation?
Yes, pregnancy is still possible after endometrial ablation, but it is rare and carries extremely high risks of serious complications including ectopic pregnancy, placenta accreta/percreta, preterm delivery, uterine rupture, stillbirth, and often requires cesarean hysterectomy. 1, 2
Critical Understanding: Endometrial Ablation Is NOT Contraception
- Endometrial ablation destroys the uterine lining but does not prevent ovulation or conception 1, 3
- The procedure should only be performed in patients who do not desire future pregnancy 4, 1
- Reliable contraception is mandatory after endometrial ablation for all women of reproductive age 2
- Pregnancy can occur anywhere from 3 weeks before to 13 years after the procedure 2
Pregnancy Outcomes After Ablation: Severe Complications Are the Rule
Non-viable pregnancies (85% in observational studies):
- Spontaneous miscarriage 2
- Ectopic pregnancy (significantly increased risk) 1, 2
- Elective termination 2
Viable pregnancies that continue have catastrophic complication rates:
- Morbidly adherent placenta (placenta accreta/percreta) - frequently reported, often requiring hysterectomy 5, 2, 6
- Preterm delivery - very high rates 1, 2
- Preterm premature rupture of membranes 5, 2
- Intrauterine growth restriction 5, 2
- Uterine rupture (including incomplete rupture) 5, 2
- Cesarean hysterectomy - commonly required due to hemorrhage 5, 6
- Stillbirth and neonatal death 1, 2
Why These Complications Occur
The ablated, scarred endometrium creates:
- Abnormal placentation with deep myometrial invasion 5, 6
- Abnormal neovascularization and fibrous adhesions 5
- Anatomical distortion of the uterine cavity 5
- Intrauterine synechiae (scar tissue) that trap pregnancies 7
Clinical Management Recommendations
For patients considering endometrial ablation:
- Counsel thoroughly about serious pregnancy risks even with concurrent sterilization (tubal ligation can fail) 5, 7
- Recommend concurrent tubal ligation/sterilization at time of ablation 1, 7
- Emphasize that reliable contraception is essential if sterilization is not performed 2
If pregnancy occurs after ablation:
- Maintain high index of suspicion - diagnosis is often delayed 5
- Early referral to tertiary care centers with multidisciplinary teams experienced in morbidly adherent placenta 5
- Pelvic MRI to assess for placenta accreta/percreta and myometrial invasion 8
- Counsel about extremely high complication rates 2
- Plan for potential cesarean hysterectomy with blood products available 5, 6
Common Pitfall
Do not assume patients are protected from pregnancy after ablation alone - approximately 80-90% of women who conceived after ablation were not using contraception when reported 2. The procedure itself provides no contraceptive protection despite destroying the endometrial lining 1, 3.