Endometriosis has a broad range of symptoms, from painful periods to immunity issues - but can it impact your fertility? Here our guest writer and fertility expert Dr Vidya Seshadri breaks down everything you need to know about endometriosis and fertility.  

Key Takeaways

 

• There does seem to be a link between endometriosis and fertility issues - but that doesn’t mean you won’t be able to conceive if you have the condition 
• If you require assisted fertility treatment, there are lots of options available to you - from IVF to surrogacy 
• Some people with endo may be able to conceive naturally! Following a healthy diet and lifestyle plan can help improve your chances 
• If you’re not ready to build a family right now but are concerned about the condition or treatment impacting your fertility, you can speak to your healthcare provider about fertility preservation options. 

Endometriosis and Fertility Issues

The sad fact is that whilst many people with endo do conceive and build families, having endometriosis may significantly impact fertility. In fact, some studies estimate that 30-50% of those living with the condition will face infertility -  and there are a few reasons why this could happen. 

Pain During Sex

Chronic pelvic pain or severe dysmenorrhea (painful intercourse) associated with endometriosis can affect sexual activity. Surveys indicate that around 80% of endo patients say the condition has a negative impact on their sex life. This can lead to reduced frequency of intercourse, which will make it more challenging to conceive naturally.

Scar Tissue and Adhesions

Endometriosis is a progressive condition that can lead to the formation of scar tissue and adhesions, which may distort the anatomy of the pelvis. This can block or damage the fallopian tubes, preventing the egg from meeting the sperm and thereby causing a delay in conception.

Issues With Ovarian Function

Endometriomas (cysts caused by endometriosis) can develop on the ovaries, affecting their function. These cysts can damage ovarian tissue, reducing the number of healthy eggs and impacting hormone production, which is crucial for ovulation. This could result in anovulation (eggs not being released when we would expect them to be) or other issues with egg health eg… 

Egg Quality

Some studies have reported an association between endometriosis and poor egg quality. When we have poor egg quality we can face numerous issues on our way to conceiving - in some cases, an egg can not be fertilised but some experts believe poor egg quality can also be linked to recurrent miscarriage. 

Immune System Dysfunction

You may not think that immunity has much to do with pregnancy, but the immune system plays an important role in embryo implantation. In individuals with endometriosis, the immune system may prevent the embryo from implanting properly in the uterine lining or lead to early miscarriage.

These factors, alone or in combination, can make it more difficult for individuals with endometriosis to conceive and maintain a healthy pregnancy. This is probably why the monthly fecundity rate (the probability of conception per menstrual cycle) in women with untreated endometriosis is estimated to be 2-10%.

Endometriosis & Fertility Treatment

 

It’s important to remember that not all individuals with endometriosis require fertility treatment to conceive. The need for fertility treatment will depend on the age of the individual, ovarian reserve and the severity of the condition.

However, if you do require help on your journey, there are various options available to you. 

Fertility Preservation

If you are hoping to have a family in the future but are concerned about your fertility, thinking about egg freezing can be a great thing to do. 

Fertility preservation is often advised for individuals diagnosed with severe endometriosis where eggs or embryos ( created with a partner’s sperm) are cryostored (frozen) for future use. 

Here are some reasons why fertility preservation might be beneficial and the options available:

Impact of Endometriosis on Ovarian Reserve

Endometriosis, especially when it affects the ovaries (endometriomas), can reduce the ovarian reserve (the number of viable eggs). This can impact fertility over time.

 

Hormonal Treatments

Certain hormonal treatments used to manage endometriosis symptoms can temporarily suppress ovarian function. While these treatments can help manage symptoms, they may delay attempts at conception.

 

Before surgical Intervention for endometriosis

Surgical treatment for endometriosis, such as the removal of endometriomas or other lesions, can sometimes affect ovarian function and reserve. Preserving fertility before such procedures can be a prudent step.

 

Progressive Nature of Endometriosis

Endometriosis is a chronic condition that can worsen over time, potentially impacting fertility more significantly as it progresses.

It is important to remember that every individual has a reproductive choice and has the autonomy to make an informed decision about their future reproductive health.

Medication

For individuals with endometriosis who are facing fertility challenges, several medication options can help improve the chances of conception, depending on your case. If your tubes are not blocked, a good first step is to try ovulation induction using agents like Clomid, letrozole or gonadotropin injections. This can help you pinpoint ovulation and regulate your cycle, so you have the best chance of conceiving. 

IUI and IVF

Alternatively, it may be advised that you need to try assisted fertility treatment like IUI or IVF. This can be especially helpful if there are issues on both the female and the male side of the partnership. Remember, just because you java endo doesn't mean that fertility struggles are necessarily down to you!   

Intrauterine insemination (IUI) is where the prepared sperm (either your partner or a donor) is placed directly into the uterus around the time of ovulation. IUI may be recommended in conjunction with ovulation-stimulating medications for mild endometriosis. 

Assisted reproduction, In Vitro Fertilization (IVF) may also be advised. The process involves eggs being retrieved from the ovaries and fertilized with sperm in a laboratory. The resulting embryos are then transferred to the uterus. IVF bypasses many of the issues caused by endometriosis, such as blocked fallopian tubes and inflammation, and is often recommended for moderate to severe cases or when other treatments have failed.

Surrogacy

In some extreme cases of endometriosis, or in situations where you have had to have a full or partial hysterectomy as part of your treatment, surrogacy can be a wonderful way to build a family. In many cases, you can use your eggs and the sperm of your partner, and go through the IVF process with a surrogate carrying your baby. There are many considerations to make when going down the surrogacy route - from the legal to the emotional - but organisations like Surrogacy UK can help you on your journey. 

 

Improving Fertility Chances With Diet & Lifestyle

 

Diet and lifestyle changes can play a significant role in improving the chances of conceiving for individuals living with endometriosis - so we should always look at this alongside (or sometimes before!) fertility treatments. 

Try to eat anti-inflammatory foods

Anti-inflammatory foods like fruits and vegetables are rich in antioxidants and nutrients that help reduce inflammation. Omega-3 Fatty Acids which are found in fatty fish (like salmon and mackerel), flaxseeds, and walnuts also have anti-inflammatory properties. Whole grains such as brown rice, quinoa, and oats, can also help stabilise blood sugar and reduce inflammation.

Limiting processed foods and sugars

Processed foods and refined sugars can increase inflammation and should be limited. Endometriosis is a full-body inflammatory disease so anything we can do to reduce inflammation will benefit both your health and fertility. It is advisable to opt for whole, unprocessed foods instead - cooking healthy meals at home from scratch can help you achieve this!

 

Reduce Your Red Meat and Dairy Intake

Some studies suggest that high consumption of red meat and dairy may exacerbate endometriosis symptoms. Plant-based protein sources such as beans, lentils, and tofu can be beneficial as an alternative.

 

Avoidance of Trans Fats

Found in many fried and processed foods, trans fats can also increase inflammation. Therefore it is recommended to choose healthy fats like olive oil, avocado, and nuts instead as they are full of other nutrients that can support your overall health.

Increased Fibre

It is advisable to increase fibre Intake with fibre-rich foods like fruits, vegetables, and whole grains. People living with Endometriosis often have higher levels of oestrogen so adding more fibre to the foods helps excrete excess oestrogen out the body.

Limit Caffeine and Alcohol

We know that high intake of caffeine and alcohol may negatively impact fertility and worsen endometriosis symptoms. That doesn’t mean you necessarily have to cut these out of your diet 100% but moderation is key.

Regular Exercise

We know that exercise if good for us, but that’s not always easy when having an endo flare-up. The Myoovi Kit can help reduce your pain and stay active, but also focusing low low-impact activities like walking, swimming, and pilates may help reduce inflammation, improve blood flow, and reduce stress.

Stress Management

Practices like mindfulness, meditation, acupuncture and deep breathing exercises can help manage stress, which is crucial as chronic stress can affect hormonal balance. Counselling or joining support groups for individuals with endometriosis can also provide emotional support and coping strategies.

Avoid Environmental Toxins

In our modern world, many toxins can affect our health and fertility - whether or not you are living with endometriosis. It’s highly advisable to reduce exposure to environmental toxins like BPAs (found in some plastics)

Supplements and Vitamins

There are many prenatal vitamins out there but not all will contain the supplements especially important for managing endometriosis. I always recommend you ensure you are taking Vitamin D, Vitamins B, Zinc and Selenium as they may help with the immune system.

A fertility journey can be stressful, especially if you are living with a condition like endometriosis, but there is lots of support out there and lots of potential options and treatment routes to help you build a family. 

Working with a healthcare provider or a nutritionist who specialises in fertility and endometriosis can help create a tailored plan that addresses individual needs and maximises the chances of conceiving. 

 

Dr Srividya Seshadri.

MBBS, MD, FRCOG, MSC, FCRI (Fellow, Clinical Reproductive Immunology, American Society for Reproductive Immunology)

Dr Seshadri is a Consultant Gynaecologist and an accredited subspecialist in reproductive medicine and surgery. Ms Seshadri’s dedication to advancing reproductive medicine is further evidenced by her role as an Honorary Associate Professor at UCL and her membership on the Executive Committee of the BFS and she is also on the Board of Trustees for The Endometriosis Foundation.