Endometriosis & Fertility

Trying to become pregnant with endometriosis can be frustrating, but you aren’t alone–an estimated 5-15% of reproductive-aged women in the US have the condition. Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus–often in and around organs in the pelvis. Those growths can be really painful and negatively impact fertility. In fact, according to the American Society of Reproductive Medicine, up to 30-50% of women with Endometriosis may experience infertility. That does not mean getting pregnant with an endometriosis diagnosis is impossible; there are actions you can take to help boost your fertility. So, what is the connection between endometriosis and fertility? Let’s dive in and discuss.

How Does Endometriosis Affect Fertility?

Infertility is clinically defined as the inability to conceive after a year of regular, unprotected intercourse or after six months if the woman is older than 35. Endometriosis is one of the leading causes of infertility in women. So, what’s the connection between endo and fertility? We don’t fully understand, but researchers theorize that it’s due to the inflammatory nature of the condition and the endometrial-like tissue that grows on the ovaries, fallopian tubes and other pelvic organs. Each month, during your menstrual cycle, the accompanying hormonal changes cause these cells to create scar tissue (adhesions/implants), making it harder to conceive. 

Endometriosis Fertility Rate

In women with endometriosis, there is a reduced chance of becoming pregnant each month; about 2-10% vs 15-20% for fertile couples. Additionally, the rate of fertility for women with endometriosis varies, with research forming a possible link between the stage of endometriosis and future fertility. At the time of your endometriosis diagnosis, your doctor will assess the severity of the condition, assigning one of the following four stages:

1. Stage 1: Minimal, which means very few implants and no visible scar tissue
2. Stage 2: Mild, which means there are more implants but still no visible scar tissue
3. Stage 3: Moderate, which means there is a lot of growth in the abdomen that creates small, fluid-filled cysts and scar tissue 
4. Stage 4: Severe, which means a significant number of endometrial implants, large endometriotic cysts and scar tissue between the uterus and the rectum (lower part of the intestines) and around the ovaries or fallopian tubes

Women with mild-moderate endometriosis report higher rates of natural pregnancy. Women with severe or later-stage endometriosis are more likely to meet the clinical criteria for infertility and need help to become pregnant. 

How to Increase Fertility with Endometriosis

If you have endometriosis and are struggling with becoming pregnant, the first step is seeking out professional support. A healthcare provider like a fertility specialist can help you determine the best course of action and thoroughly explain your options. You can also implement a few lifestyle changes to support your journey. Adopting an anti-inflammatory diet with minimal sugar, caffeine, alcohol and red meat may help. Additionally, getting at least some form of physical activity or exercise is always good for overall health. Ensuring you are in good health, even if you aren’t planning to conceive right now, is one of the best ways to aid your future self in your dreams of having a family.

Endometriosis Fertility Treatment

Unfortunately, there is no cure for endometriosis, though emerging research and a new wave of interest in female reproductive disorders are yielding promising results. That doesn’t mean all hope is lost. Advances in hormonal research and a better understanding of how the female reproductive system functions have provided us with the tools to help women on their fertility journey. Whether you opt for medical fertility treatments or want to try a natural approach, at Allara, we want to ensure you have the education to understand your options thoroughly.

Medical Treatments for Endometriosis 

For women who cannot become pregnant naturally, there are several options available that focus on improving fertility chances by reducing or eliminating endometrial implants and scar tissue.

• Medical Intervention: The first line of treatment to reduce endometrial implants is usually hormonal medications such as combined oral contraceptives, progestins, and gonadotropin-releasing hormone agonists or antagonists (GnRH analogs). These medications suppress ovulation, allowing your pelvic organs time to heal while reducing implants and scar tissue. You would have to come off of the medication before trying to conceive.
• Surgical Treatment: Removing implants via laparoscopic surgery or ablation is another option performed in preparation for conception. some text
  • In one study, women with mild-moderate endometriosis saw a 13% increase in pregnancy probability post-surgery.  
  • Even in cases of severe endometriosis, surgery shows promising results in restoring normal pelvic function and reducing inflammation.
• Assisted Reproductive Technologies (ART): Studies show an increase in ovulation and pregnancy in cases of mild-moderate endometriosis who opt for intrauterine insemination (IUI). Unfortunately, there isn’t enough data about the success rates of later-stage endometriosis and ART treatments.

Vitamins & Supplements for Endometriosis Fertility

In addition to lifestyle changes, you can look into certain supplements that support and prepare your body for fertility. The most popular vitamins and supplements for endometriosis are:

• Vitamin D: Vitamin D3 increases anti-inflammatory proteins. Vitamin D receptors and metabolizing enzymes are found in the ovaries and endometrium of women with and without endometriosis, meaning vitamin D may play a role in ovary function.
• Zinc: This essential mineral is vital in inhibiting free radical production and protecting against oxidative damage. While there are no animal studies on a direct link between zinc and endometriosis, researchers found that women with the condition had lower zinc levels in their diets.
• Magnesium: Researchers established a connection between magnesium levels and reproductive health years ago. Magnesium deficiencies were observed in premenstrual syndrome, and since magnesium relaxes smooth muscles, it may positively affect retrograde menstruation, which is thought to be one of the main causes of endometriosis. 

You can find many of the above supplements in foods, such as leafy green vegetables, poultry, nuts, and fatty fish (salmon and tuna). But that doesn’t mean you can’t add vitamins to your daily regimen; just ensure you take high-quality, bio-available supplements. 

Pregnancy with endometriosis isn’t impossible; you just need the right support team in your corner. At Allara, we offer specialized treatment plans tailored to people with endometriosis who want to start or grow their families. Our holistic approach to hormonal and fertility care includes comprehensive testing, coaching, and medication when appropriate. Explore an Allara membership to learn more about how we can support your journey.