Navigating early pregnancy surveillance, fertility and endometriosis, with Oskari Heikinheimo

In a second interview with Oskari Heikinheimo, Department of Obstetrics and Gynecology, Helsinki University Hospital, and University of Helsinki, he explains risks of ectopic pregnancies that are linked to endometriosis, and if and when patients should undergo earlier pregnancy surveillance.

The conversation stems from Heikinheimo and colleagues’ findings that were recently published in the American Journal of Obstetrics & Gynecology, which highlighted that those with surgically verified endometriosis face significantly higher risks of early pregnancy complications—including miscarriage and ectopic pregnancy—compared with those without the condition.

Among pregnancies with known outcomes, births were less common in the endometriosis cohort (72.0% vs 75.7%, respectively), whereas miscarriage (15.6% vs 10.4%) and ectopic pregnancy (3.5% vs 1.5%) were significantly more frequent. After adjustment, endometriosis was associated with a 51% higher risk of miscarriage and more than a 2-fold increased risk of ectopic pregnancy. By contrast, the risk of induced abortion was lower, and there was no difference in the risk of molar pregnancy.

Contemporary OB/GYN:

Given the roughly 2.5-fold increased risk of ectopic pregnancy, do you believe patients with known endometriosis should undergo earlier or more intensive early-pregnancy surveillance?

Heikinheimo:

I wouldn't recommend screening or recommending a routine, let's say very early pregnancy ultrasound for women with endometriosis. I'm sure many would like to do it anyways, but, but being aware that there is this risk is important. You advise the patients that if [they] have some abnormal symptoms during early pregnancy, [go and see their physician].

Contemporary OB/GYN:

Your study shows a lower lifetime pregnancy incidence in patients with endometriosis. From a clinical standpoint, when should general OB/GYNs consider earlier fertility referral or proactive reproductive planning discussions?

Heikinheimo:

Well, I would say that if there is a suspicion of endometriosis, and the patient has endometriosis symptoms and has pregnancy intentions, then getting the diagnosis, or at least discussing the reduced fertility, is important, maybe encouraging, not to postpone the pregnancy, the plans of getting pregnant, that would be very important. Of course, it's very difficult for us to say that ‘Well, now you have to start getting pregnant at a very early age because you are likely to have endometriosis.’ No, you can't really say that to a patient.

Click play on the video above to watch the full conversation.

For more on the findings published in the American Journal of Obstetrics & Gynecology, click here.

Reference:

Gurney JM, Tuominen A, Saavalainen J, et al. Endometriosis and early pregnancy outcomes: a registry-based cohort study in Finland. Am J Obstet Gynecol. 2026 doi:10.1016/j.ajog.2026.01.027.