How Endometriosis Affects Your Fertility (And What You Can Do About It)
Endometriosis can affect your fertility well before you even think about getting pregnant. This condition, where tissue similar to that found inside your uterus grows outside your uterus, affecting your pelvic organs, affects about one in ten women of childbearing age. But if you’re one of those trying to get pregnant, your chances are much lower. Women with endometriosis have a much lower chance of falling pregnant each month.
However, getting a diagnosis doesn’t mean you can’t get pregnant. With the right support, correct timing, and a good understanding of how your body is affected by your condition, many women suffering from endometriosis have successfully conceived and carried their babies to term. But, of course, you have to have a good idea of what you're working with, so to speak.
If you already have an endometriosis diagnosis or are experiencing unexplained infertility, then our women's health team at Floralia Wellness can assist you, together with your fertility specialist, to develop a treatment plan that addresses your whole health picture.
How endometriosis interferes with getting pregnant
Endometriosis does not impact conception in one simple manner. Instead, it disrupts your body in a multitude of ways. This is why treatment is tailored to the individual. Studies have shown that the infertility caused by endometriosis is a result of the interrelation of inflammation, anatomic disruption, endometrial receptivity, and hormonal disruption.
Inflammation and egg quality
Another hidden way in which endometriosis affects conception is through inflammation in the pelvic cavity. Endometriosis tissue outside the uterus causes an autoimmune response. This response leads to the production of reactive oxygen species that affect the quality of eggs as well as sperm. Even if the fallopian tubes are clear and ovulation is happening normally, the quality of eggs may be compromised before any fertilisation occurs.
The discussion about endometriosis and fertility does not normally include this. Instead, the discussion centres on structural problems, but inflammation is also a major factor in whether or not conception occurs in any given month.
Scar tissue and blocked fallopian tubes
As the endometrial tissue develops, bands of scar tissue can form, causing organs to be pulled out of alignment or stick together in the wrong position. In the case of moderate or severe endometriosis, the scar tissue can physically block the fallopian tubes, preventing the egg and sperm from meeting.
A partially blocked fallopian tube is just as problematic as a fully blocked one. A tube that is kinked, or partially closed with scar tissue, may be technically open, but functionally closed, with the chances of conception reduced without the sufferer realising there is a physical problem.
Endometriomas and ovarian reserve
Endometriomas are cysts that develop on the ovaries as a result of the growth of endometrial tissue into the ovarian tissues. These cysts may affect the normal tissues around them and eventually reduce the number of normal eggs. This is an important factor for women who are not yet trying to conceive because the reduction happens gradually.
This is one of the reasons why fertility preservation discussions need to occur as soon as the diagnosis of endometriosis is made, even if pregnancy is not in the immediate future. If you’re unsure of your hormone status, hormone testing may help sort out your hormonal situation.
Hormonal disruption and implantation failure
Endometriosis may disrupt hormonal preparation for implantation in the uterine wall. When progesterone and estrogen hormones are disrupted in a woman’s body, it may affect implantation in the endometrial wall. A woman may ovulate and fertilise eggs but still not conceive because the endometrial wall may not be prepared for implantation.
Such a hormonal imbalance may also interfere with the timing of implantation, resulting in a mismatch between the time the embryo reaches the uterus and the time the window is available. Studies into the pathophysiology of endometriosis have implicated progesterone resistance, adhesions, and folliculogenesis as major factors in the difficulty experienced in implantation.
Does the endometriosis stage affect your chances?
There are four stages of endometriosis, ranging from minimal (Stage I) to severe (Stage IV), depending on the location, depth, and size of endometrial growths. One might expect that as endometriosis progresses to a more severe stage, so do the chances of conception; this is somewhat true, as endometrial growths increase, so does the risk of infertility.
However, this does not tell the whole story. Some women with mild endometriosis have difficulty with infertility, while others with Stage III or IV disease conceive easily without any help. This is due to the exact location of the endometriosis growths, the presence or absence of endometriomas or blocked fallopian tubes, as well as the amount of inflammation present.
What it does help with is treatment planning. For women who are at Stage III or IV endometriosis, pregnancy rates may increase if large cysts or scar tissue are surgically removed, while women at Stage I or II may do well if their doctor supports ovulation alone. If you have been diagnosed with endometriosis, a naturopath specialising in endometriosis can help you understand what this means in terms of treatment planning for your specific case.
Signs your fertility may be affected
Not all women suffering from endometriosis experience fertility problems, but there are certain signs that you should take seriously. Painful periods, pelvic pain, and pain during sex are common signs of endometriosis. Even though these signs do not automatically mean you have fertility problems, they do mean your endometriosis is active, which could mean that your condition is progressing.
Changes in your period pain, such as increasing pain or pain between periods, especially if you experience pain while using your bladder or bowel, could mean that your endometriosis is affecting other parts of your body, not just your uterus. If your pain is getting worse and needs to be managed with painkillers, then you should seriously think about getting help. At Floralia, our practitioners specialise in helping with painful periods, as well as endometriosis.
When to see a fertility specialist
If you know that you have endometriosis and have been trying to conceive for six months without success, it is recommended that you seek advice from a fertility specialist instead of waiting for a period of twelve months. This longer period is recommended because endometriosis is a progressive disease and will get worse with time. The longer you wait, the more tissue will form and damage your reproductive organs.
A thorough evaluation will provide you with a clear picture of what is happening and what treatment is best for you by checking tubal patency, ovarian reserve, sperm count in your partner’s semen, and your hormone levels.
Fertility treatment options for women with endometriosis
There is no specific fertility treatment that will work for all women with endometriosis. The treatment will depend on your stage of the condition, your age, your ovarian reserve, and the length of time it has taken you to conceive. Treatment for endometiosis may include:
Surgical removal of endometrial tissue through a method called laparoscopic surgery
For women suffering from endometriosis-related structural problems, keyhole surgery is often the first choice. This is a method in which a surgeon can successfully remove endometrial tissue and adhesions, as well as cysts, while preserving as much tissue as possible.
For many women, their chances of becoming pregnant are greatly increased after this type of surgery, especially for those women suffering from scar tissue in the fallopian tubes or endometriomas that affect the ovaries. Some women even become pregnant shortly after the surgery. However, this is not guaranteed for all women, and the time frame for increased fertility is limited before tissue regrowth occurs.
Ovulation support with clomiphene citrate and IUI
For women with Stage I or Stage II endometriosis, clomiphene citrate is a fertility drug that can induce ovulation. This can increase the chances of conception. When IUI is also performed, it is a less aggressive approach that can be tried before more aggressive treatment is undertaken.
This is a more effective approach if the fallopian tubes are clear and there are no large endometriomas. This is less aggressive than IVF and can be a good starting point for mild endometriosis.
When IVF is recommended
In vitro fertilisation is usually recommended when a woman has not become pregnant after six to twelve months of surgical treatment for moderate or severe endometriosis, or when other forms of treatment have failed. IVF also circumvents the challenges posed by endometriosis because it does not require the woman to have normal fallopian tubes and because the quality of the embryos can be checked before they are transferred. For some women, especially those with considerable damage to the fallopian tubes or reduced ovarian reserve, IVF can provide a faster journey to pregnancy. The good news is that a recent study, based on data from nearly 52,000 women, concluded that endometriosis in all stages does not significantly affect live birth rates after IVF, though there was a slightly adverse impact on implantation rates.
Egg and embryo freezing as a fertility safeguard
Women with endometriosis, especially if they are not yet ready to conceive or may need more surgeries in the future, may want to consider egg or embryo freezing. Every surgery on the ovaries risks damaging ovarian reserve, and endometriomas can cause constant damage.
It is important to consider egg/embryo freezing early on, before you want to conceive, as soon as possible after diagnosis, especially if you are not yet ready to conceive. This is because, at a young age, the quality and quantity of eggs are high.
The role of naturopathic and integrative support
While traditional fertility treatments can alleviate the structural and hormonal challenges that endometriosis can cause, there is another level of support that is available, a level that is complementary to the traditional treatments, but which can provide support for the reduction of inflammation, egg quality, hormonal balance, and preconception care, which is not always covered in conventional treatments.
This is where naturopathic and integrative care come in. At Floralia Wellness, naturopathic and integrative care is provided alongside your fertility specialist or gynaecologist, in addition to your conventional treatment. Our naturopaths take a holistic view of your health, which means we look at all of the relevant pieces when developing a treatment plan. This includes your history, details about your menstrual cycle and symptoms, a thorough understanding of your pain picture, looking at blood tests and also your dietary patterns. Chronic stress and your diet are also driving factors of endometriosis symptoms, so we take this into account, too. The aim is to create the most conducive environment in your body for conception. Fertility treatment is a challenging process, and having support through the integrative care process can actually make a big difference. You can learn more about how this is done on our fertility naturopath page.
Once we have this information, we can then develop a treatment plan to address the issues that you face specifically, using herbal medicines, support and coaching to adjust your lifestyle. Natural treatments for endometriosis are not as fast-acting as, say, having a laparoscopy or using hormonal drugs. They do, however, work at supporting the body to heal and restore optimal fertility.
Anti-inflammatory nutrition for reproductive health
One of the most accessible tools available to women who have endometriosis and are trying to conceive is an anti-inflammatory diet. This is so because endometriosis, at its core, is an inflammatory disease, and food can either fuel it or calm it.
In the clinic, Floralia’s naturopaths develop a nutrition plan that is unique to your bloodwork, your symptoms, and where you are in your treatment process. This is not just a generic "fertility diet" that you can find online anywhere. This could mean, for example, increasing your intake of omega-3 fatty acids to affect prostaglandin production, or decreasing your intake of refined carbohydrates to increase your insulin sensitivity, which affects oestrogen metabolism. Or, it could mean figuring out what individual foods you have sensitivities to, which could be affecting your body’s inflammatory processes. The details matter, and these details change depending on where you are in your process. Working with a clinical nutritionist ensures that your nutrition plan is well-rounded.
Herbal medicine and acupuncture alongside conventional care
Herbal medicine has a long tradition of use in maintaining reproductive well-being, and certain botanical medicines, when prescribed by a qualified naturopath, have been shown to have a positive effect in modulating inflammation and balancing progesterone levels and uterine blood flow. These are not medicines that you would take on your own; they need to be specifically chosen to avoid interactions with fertility drugs and tailored to your individual hormonal profile.
Another method that Floralia uses is acupuncture, which is often helpful to women as a means of managing endometriosis discomfort. Acupuncture can also help to promote blood flow to the uterus as well as reduce stress during IVF cycles. Acupuncture can be part of an overall integrative treatment plan to help support a woman’s IVF cycle. Floralia has specialised fertility acupuncture sessions to help support you.
Why your partner’s health matters too
Any discussion of fertility related to endometriosis tends to centre entirely on the woman, which is perhaps understandable as she is the one being diagnosed. However, it’s worth remembering that conception requires two components: an egg cell and a sperm cell, so it’s also important to consider your partner’s sperm count, sperm motility, as well as the overall quality of sperm.
This is particularly relevant if your chances of conception are already being diminished by your endometriosis. If your sperm quality is not ideal, then your chances could be further reduced. A naturopathic assessment of your partner can help identify factors such as oxidative stress, nutritional deficiencies, and lifestyle factors that are negatively impacting their sperm quality. This can greatly help your chances of conception without adding further complexity to your care. At Floralia, male infertility support is not an afterthought, but rather part of the conversation about your fertility.
Is it possible to conceive naturally with endometriosis?
Yes, it is. Many women with endometriosis can conceive naturally, especially if they have a mild case of endometriosis, also known as Stage I or Stage II endometriosis. This is because there is less or no damage to the fallopian tubes and ovaries. Although it is less likely for women with endometriosis to conceive naturally, it is by no means impossible. The chances of conceiving depend on a variety of factors, including age, endometriosis severity, duration of attempts, and other fertility-related issues. If you are experiencing a mild case of endometriosis and have been trying for less than six months, you can conceive naturally. However, if you are experiencing a severe case of endometriosis with known fallopian tube problems, it is more likely that you will conceive with the help of technology.
The important thing is not to wait too long before getting a clear assessment.
What to expect during pregnancy with endometriosis
The good news is that most women with endometriosis have a healthy and uncomplicated pregnancy that does not require any special tests or monitoring. In fact, pregnancy often relieves symptoms of endometriosis temporarily due to hormonal changes that maintain high progesterone levels.
However, it’s helpful to be aware of some potential complications so that you can work with your healthcare provider to manage them.
Risks associated with pregnancy in women with endometriosis
The figures are reassuring in general, but a handful of specific risks are increased and worth being made aware of. Women with endometriosis are 1.5 times more prone to having a premature birth than those without it. There’s also a link with pre-eclampsia and increased placenta previa, which is when the placenta covers some or all of the cervix.
Endometriosis has also been associated with a greater risk of miscarriage. It’s worth noting that this doesn’t mean that a miscarriage or any other complications will definitely occur. However, by informing your doctor or midwife about your endometriosis diagnosis, they may be able to monitor your pregnancy more closely. Floralia’s pregnancy clinic offers naturopathic care throughout your pregnancy, should you have a complex medical history such as endometriosis.
Managing symptoms while pregnant
The usual methods of managing endometriosis symptoms, such as hormone treatments, surgery, pain relief medication, and anti-inflammatory drugs, are not safe during pregnancy. For most women, endometriosis symptoms improve during pregnancy because of the hormonal changes. However, if pain is a problem, there are safe ways of managing it during pregnancy, and a team of professionals can help you with that.
Exercise, especially gentle forms of it, and the use of heat can help with managing symptoms, and a women’s health physiotherapist can provide more options for you. Your naturopath can also provide guidance on safe ways of managing symptoms during pregnancy.
Does pregnancy cure endometriosis?
No. This is one of the most enduring myths about endometriosis, and it’s a destructive one when women are told to “just get pregnant” as if it’s a solution to their problems.
Pregnancy does relieve symptoms of endometriosis temporarily because the high levels of progesterone hormones create a less hospitable place for endometrial cells to thrive. Many women report that they feel much better when they’re pregnant.
However, this does not mean that endometrial cells have gone away. When a woman gives birth and menstruation resumes, symptoms often return. Some women report that their symptoms change after pregnancy, sometimes for the better.
Building your care team early
Endometriosis and fertility are not something that should be worked out alone or under pressure. The sooner you surround yourself with people who understand your diagnosis and are knowledgeable in this area, the more chances and the more effective the chances are for conception.
This may include your doctor and a gynaecologist or fertility specialist, as well as an integrative practitioner, such as a naturopath, who can help your body cope with the medical interventions and recommend. The sooner and more individualised the care for your body, the higher the success rates for conception.
