Updated:
by
Laura Kelsey, MD
Medically reviewed by Laura Kelsey, MD
You have probably heard many explanations for why getting pregnant is hard. Hormones. Age. Stress. A long list of things that are difficult to control and even harder to talk about. But there is one factor that rarely comes up in those conversations, even though it sits at the center of your reproductive anatomy: your veins.
Vein disease is one of the most common conditions in women, and pregnancy is one of its most significant triggers. Yet it is also one of the least discussed topics in conversations about fertility. That disconnect has real consequences. When the veins that supply blood to the pelvis, ovaries, and uterus are not working properly, the effects can extend well beyond swollen legs or visible spider veins. For some women, those effects include irregular cycles, chronic pelvic pain, and difficulty conceiving.
This is not a fringe theory. It is supported by a growing body of peer-reviewed research, and it points to a specific condition that deserves far more attention than it gets.
That’s why we consulted with a vein expert, Laura Kelsey, MD, lead physician at Center for Vein Restoration (CVR) vein clinics in Grand Rapids, Michigan, and Muskegon, Michigan. She advised us on what women with pelvic symptoms need to know before drawing conclusions about their pelvic pain as it relates to their fertility.
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Vein disease affects both sexes, but women carry a disproportionate share of it. About 23 percent of U.S. adults have varicose veins, according to the American Heart Association Journal Circulation, and women are significantly more affected than men at every age. The reason is largely hormonal.
Estrogen and progesterone, the primary female sex hormones, directly affect the structure of vein walls. Research published in a peer-reviewed NIH/PMC study found that vein tissue in women with varicose veins shows significantly higher levels of estrogen and progesterone receptors than healthy vein tissue, suggesting that sex hormones play a direct role in how veins develop and degrade over time.
Progesterone, in particular, relaxes smooth muscle in the walls of the veins. When levels rise, as they do during the menstrual cycle, pregnancy, and while using hormonal contraceptives, vein walls can lose tone and valves can weaken. According to PubMed-indexed research, progesterone inhibits smooth muscle contraction, which can cause valves to fail to close properly, allowing blood to flow backward and pool. Estrogen compounds the problem by relaxing the bonds between collagen fibers in vessel walls.
This hormonal vulnerability is not a minor footnote. It means that the same biological processes that govern a woman's reproductive life, from her monthly cycle to each pregnancy, are also shaping the health of her veins.
Most people are familiar with varicose veins as a leg problem, and that is often where the conversation stops. But varicose veins in the legs and pelvic venous insufficiency are not the same condition. They can share the same root cause, faulty vein valves that allow blood to pool and pressure to build, driven by the same hormonal vulnerabilities described above.
However, having visible varicose veins in your legs does not mean you have pelvic venous disease, and many women with pelvic congestion syndrome have no visible leg veins at all. The fertility connection in this piece runs specifically through the pelvic venous system, not the leg veins themselves.
That distinction matters.
That brings us to pelvic congestion syndrome (PCS), also called pelvic venous insufficiency, which occurs when the ovarian and pelvic veins become enlarged and reflux, meaning blood flows backward instead of returning efficiently to the heart. It is estimated to affect anywhere from 2.1percent to 24 percent of women between the ages of 18 and 50, and it accounts for nearly 10 percent to 20 percent of all gynecological consultations for chronic pelvic pain, according to the National Library of Medicine (NIH). Yet only 40 percent of diagnosed cases receive specialized care.
That care gap matters because PCS is often misdiagnosed as other conditions. Research published in PMC notes that PCS overlaps clinically with endometriosis and adenomyosis, sharing symptoms like dysmenorrhea (painful menstruation), dyspareunia (painful intercourse), and chronic pelvic pain. Without imaging specifically designed to evaluate venous reflux, the venous origin of a patient's symptoms may go undetected on standard workup.
The symptoms to know include:
Because these symptoms can have multiple explanations, PCS remains chronically underdiagnosed despite being a well-established medical condition. For women who have cycled through specialists without answers, that is worth knowing.
A Clinical Perspective
"Pelvic venous disease is one of the most underrecognized contributors to chronic pelvic pain in women of reproductive age," says Sanjiv Lakhanpal, MD, FACS, President and CEO of Center for Vein Restoration:
"When a woman has been dismissed or told her symptoms are unexplained, a thorough venous evaluation can be the turning point. We see this regularly in clinical practice, and the outcomes after proper diagnosis and treatment are meaningful."
— Dr. Sanjiv Lakhanpal
Here is where the research becomes particularly compelling for women navigating infertility.
According to NIH/PMC research, menstrual disorders, including heavy bleeding and abnormal cycle timing, occur in up to 54 percent of women with PCS. Irregular cycles are one of the most direct barriers to conception, and when their cause is vascular rather than hormonal in origin, standard fertility evaluations may not catch it.
The disruption runs deeper than cycle timing.
The ovarian veins originate from a venous network that directly surrounds the ovaries, and research published in the Journal of Clinical Medicine notes that the ovaries are exposed to estrogen concentrations roughly 100 times higher through this vascular system than in other venous territories. When those veins become engorged and refluxing, that intimate anatomical relationship means disrupted circulation is not simply a downstream effect.
Notably, up to 50 percent of women with PCS show cystic changes to the ovaries, and polycystic ovarian change occurs at three times the rate in women with PCS compared to the general population, according to research in the Journal of Clinical Medicine. The relationship between ovarian vein reflux and ovarian function is an active area of research, but the structural and circulatory overlap is difficult to ignore.
Multiple pregnancies are a primary cause of pelvic congestion, not the other way around. During pregnancy, the same pressure dynamics that drive varicose vein formation in the legs can build in the gonadal vein (the vein responsible for draining blood from the reproductive organs, the ovaries in women and the testicles in men, and returning it to the heart), leading to swollen twisted veins around the ovaries. Each subsequent pregnancy can compound that effect.
Dr. Laura Kelsey, Center for Vein Restoration vein specialist, put it plainly:
“Multiple pregnancies contribute to pelvic congestion far more often than pelvic congestion contributes to infertility. The evidence for a link to infertility is not strong. What is well-documented, however, is the pain caused by pelvic varices, and for women who are trying to conceive, pain with intercourse is not a minor issue. That is where the real impact on fertility tends to show up.”
– Dr. Laura Kelsey
That distinction matters for women navigating both pelvic symptoms and fertility questions. PCS does not appear to directly block conception, but the pain before, during, or after sexual intercourse it causes can make intercourse uncomfortable enough to become a practical obstacle.
For women who require treatment, the approach depends on the underlying cause. Ovarian vein reflux and May-Thurner syndrome, a congenital compression of the pelvic vein by the iliac artery, can each contribute to PCS independently or together. For younger patients, embolization is generally preferred over stenting because it avoids placing a permanent device in the body; stenting carries longer-term considerations that require careful discussion with a specialist.
The relationship between vein disease and reproductive health is not one-directional. Pregnancy itself is one of the most significant risk factors for venous disease, and women who enter pregnancy with pre-existing vein problems face a compounded set of risks.
A growing uterus compresses the large pelvic veins, restricting blood return from the legs. At the same time, blood volume increases by roughly 50 percent, and progesterone levels surge, further relaxing vein walls. Chronic venous insufficiency is estimated to occur in up to 80 percent of pregnant women to some degree.
For women with pre-existing varicose veins, the stakes are higher. Women are up to five times more likely to develop deep vein thrombosis (DVT) during pregnancy compared to non-pregnant women of the same age. Varicose veins are a recognized independent risk factor for DVT during pregnancy. One large study examining DVT and associated complications found varicose veins carried an odds ratio of 9.678 for DVT risk in pregnant women, a striking figure that underscores why vein health should be part of preconception planning.
Pulmonary embolism, the most serious complication of DVT, is one of the leading causes of maternal death in the developed world. This is not meant to alarm, but to make the case that venous disease in a woman who is trying to conceive is not just a cosmetic or comfort issue. It is a health issue with direct implications for pregnancy safety.
Are you concerned about your DVT risk? Center for Vein Restoration experts can provide clarity and support as you navigate your treatment options and manage your care and recovery every step of the way. We also offer a DVT rule-out service for same-day or next-day diagnosis and treatment planning. Call our hotline at 877-SCAN-DVT (877-722-6388).
If any of the above sounds familiar, the most important step is getting a proper vascular (vein) evaluation. That means more than a simple visual check of your legs. It means a comprehensive duplex ultrasound performed by a qualified vein specialist who can assess blood flow patterns in both the superficial and deep venous systems and, in some cases, evaluate pelvic venous anatomy.
Treatment for venous insufficiency has advanced significantly. Minimally invasive outpatient procedures can close off faulty veins without surgery, and these vein treatment options are covered by most insurance plans when medically necessary.
If you have already been through the standard fertility workup and still seek answers, or if you have chronic pelvic pain that has never had a clear explanation, a vein evaluation may offer insight that other specialists have not.
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Your vein health and your reproductive health are not separate systems. They share the same hormonal drivers, the same anatomy, and in many cases, the same vulnerabilities.
Pelvic pressure, painful periods, varicose veins in unusual places, or unexplained infertility may share a vascular root. Talk to a CVR vein specialist who can evaluate the full picture.
1. Can varicose veins actually cause infertility? Varicose veins alone are not a direct cause of infertility, but pelvic venous insufficiency, the same underlying condition that causes varicose veins in the legs, can disrupt ovarian function, cause irregular cycles, and create structural changes in the pelvic environment that make conception more difficult. If you have visible varicose veins and unexplained fertility challenges, a vascular evaluation is a reasonable next step.
2. How do I know if my pelvic pain is related to vein disease rather than something like endometriosis? The symptoms of pelvic congestion syndrome and endometriosis overlap significantly, which is one reason PCS is so frequently missed. A key distinguishing feature of PCS is that pain tends to worsen with standing, walking, or prolonged activity and improves when lying down, while a definitive diagnosis requires imaging that specifically evaluates venous reflux, not just a standard gynecological workup.
3. I have pelvic congestion syndrome. Does it affect my ability to get pregnant?
PCS is more often a consequence of multiple pregnancies than a cause of infertility, and current evidence does not strongly support a direct link between pelvic varices and the inability to conceive. The more relevant concern for women with PCS who are trying to get pregnant is pain during intercourse, which can be a real practical barrier. If you have PCS and fertility questions, the best conversation is with both a vein specialist and your OB or reproductive endocrinologist.
4. Is it safe to treat vein disease before or during pregnancy? Most vein treatments are elective and typically deferred until after delivery, but getting evaluated before pregnancy is genuinely valuable. Identifying and documenting venous insufficiency before you conceive gives your care team important information for managing your risk during pregnancy, particularly around DVT prevention, and puts you in a stronger position to pursue treatment once it is appropriate.
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