Endometriosis and Fertility: A Complex Relationship

Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. It can cause a variety of symptoms, including:

Chronic pelvic pain
Painful periods
Heavy bleeding
Irritable bowel syndrome (IBS) symptoms
Difficulty getting pregnant

Endometriosis and infertility are often intertwined, with many people experiencing challenges conceiving due to this condition. Not everyone with endometriosis has infertility. Additionally, not everyone with infertility due to endometriosis has other symptoms of endometriosis. While we still have a lot to learn about endometriosis and fertility, research has shed light on several key factors contributing to this complex relationship.

The Role of Genetics and the Environment

Recent research suggests that genetic factors and environmental influences also play a role in the development of endometriosis and its impact on fertility. While these areas require further investigation, they highlight the complex nature of this condition.

How Endometriosis Impacts Fertility

Inflammation: A hallmark of endometriosis is chronic inflammation. This inflammatory environment can negatively impact:

Egg quality and ovulation: Increased inflammatory cells can disrupt ovulation and affect oocyte production.
Sperm function: The hostile environment can damage sperm, reducing their ability to fertilize an egg.
Embryo development: Inflammation can create a toxic environment for the developing embryo, hindering its growth.
Fallopian tube dysfunction: Inflammation and other factors associated with endometriosis can impair the normal function of the fallopian tubes, making it difficult for eggs to reach the uterus.

Endometrial abnormalities: Endometriosis also affects the lining of the uterus (endometrium). Changes in gene expression, hormone levels, and tissue composition can hinder the implantation of a fertilized egg. Additionally, many people with endometriosis also suffer from adenomyosis, which impacts the uterus.

Hormonal imbalances: Endometriosis influences hormone levels, and imbalances can disrupt the menstrual cycle and ovulation, impacting fertility.

Surgery for Infertility with Endometriosis

A study of women with severe endometriosis who underwent fertility-preserving laparoscopic surgery found encouraging results:

Improved pregnancy rates: Despite the severity of their condition, a significant number of women were able to conceive after surgery.
Spontaneous conception: Many women were able to achieve pregnancy naturally without resorting to assisted reproductive technologies (ART).
No significant impact of age or disease severity: Factors such as age, stage of endometriosis, and extent of surgery did not significantly affect fertility outcomes.

Another study examined the impact of laparoscopic surgery on women with unexplained infertility and at least three failed IVF attempts. The results were promising:

High rates of endometriosis: Over half of the women were diagnosed with endometriosis, a condition often overlooked in cases of unexplained infertility.
Improved fertility outcomes: Women with endometriosis who underwent laparoscopic surgery had significantly higher pregnancy rates compared to those with unexplained infertility.
Potential for avoiding IVF: The study suggests that laparoscopic surgery could help prevent unnecessary IVF cycles for women with unexplained infertility.

These findings highlight the importance of considering laparoscopic surgery as a potential treatment option for women struggling with infertility, especially before starting ART.

Supporting Your Fertility Journey: A Holistic Approach to Endometriosis

If you're struggling to conceive due to endometriosis, you're not alone. An estimated 30–50% of women with endometriosis have infertility. While conventional medicine offers valuable treatments, a holistic approach can provide additional support and improve your chances of success.

Prioritizing Surgical Intervention

Before diving into alternative therapies, it's crucial to address the root of the problem. An endometriosis excision specialist is skilled in surgically removing endometrial tissue, an essential step in improving fertility outcomes. This procedure can alleviate pain, reduce inflammation, and create a more favorable environment for conception. Talk with your doctor to see if you are a candidate for laparoscopic surgery if you suspect that you have endometriosis.

Building a Comprehensive Support Team

Consider working with a team of specialists to address the various aspects of endometriosis and fertility.

Registered Dietitian: Nutrition plays a vital role in reproductive health. An endometriosis dietitian can provide personalized guidance on optimizing your diet to support ovulation, egg quality, endometriosis symptoms, and overall well-being. They can help identify food sensitivities, manage inflammation, and create meal plans tailored to your needs.
Pelvic Floor Physical Therapist: Pelvic floor dysfunction is common in women with endometriosis and can impact fertility. A pelvic floor physical therapist can help address pain, improve muscle function, and enhance sexual function, all of which are essential for conception.
Therapist: The emotional toll of endometriosis and infertility can be significant. A therapist can provide support, coping strategies, and tools to manage stress and anxiety, which can positively impact fertility.
Acupuncturist: Acupuncture has been used for centuries to treat various health conditions, including infertility. It may help regulate hormones, reduce inflammation, and improve blood flow to the reproductive organs.

The Benefits of Complementary Therapies

While these therapies do not cure endometriosis, they can complement your care plan and offer additional support. By working closely with your healthcare providers, you can create a personalized approach that addresses both the physical and emotional aspects of your fertility journey.

Remember, every person's experience with endometriosis and fertility is unique. Listening to your body, trusting your instincts, and finding what feels right for you is essential. With patience, perseverance, and a holistic approach, you can increase your chances of achieving your dream of becoming a parent.

The Importance of Specialized Care

Given the multifaceted nature of endometriosis and its impact on fertility, seeking specialized care is essential. A comprehensive evaluation by a healthcare provider experienced in endometriosis can help identify underlying factors and develop a personalized treatment plan.

Nutrition for Endometriosis and Fertility

If you’re trying to become pregnant, it’s a great time to start eating to improve your chances for conception and a healthy pregnancy! Working with an endometriosis and fertility dietitian is a great way to support your goals for building a family.

Nutrition for Fertility

Disclaimer: This blog post is intended for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional for diagnosis and treatment of endometriosis and infertility.

Sources:

Macer, M. L., & Taylor, H. S. (2012). Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynecology Clinics, 39(4), 535-549. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/pdf/nihms422379.pdf

Farland, L. V., Prescott, J., Sasamoto, N., Tobias, D. K., Gaskins, A. J., Stuart, J. J., … & Missmer, S. A. (2019). Endometriosis and risk of adverse pregnancy outcomes. Obstetrics & Gynecology, 134(3), 527-536. Retrieved from https://journals.lww.com/greenjournal/Citation/2019/09000/Endometriosis_and_Risk_of_Adverse_Pregnancy.14.aspx

Nesbitt-Hawes, E. M., Campbell, N., Maley, P. E., Won, H., Hooshmand, D., Henry, A., … & Abbott, J. A. (2015). The surgical treatment of severe endometriosis positively affects the chance of natural or assisted pregnancy postoperatively. BioMed research international, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515280/pdf/BMRI2015-438790.pdf

Young, K., Kirkman, M., Holton, S., Rowe, H., & Fisher, J. (2018). Fertility experiences in women reporting endometriosis: findings from the understanding fertility management in contemporary Australia survey. The European Journal of Contraception & Reproductive Health Care, 23(6), 434-440. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30481080/

Rizk B, Turki R, Lotfy H, Ranganathan S, Zahed H, Freeman AR, Shilbayeh Z, Sassy M, Shalaby M, Malik R. Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect? Facts Views Vis Obgyn. 2015;7(2):109-18. PMID: 26177374; PMCID: PMC4498168.

Endometriosis and Fertility