Endometriosis and fertility

endometriosis and fertility

Discover 5 ways endometriosis impacts your fertility, as well as how to support yourself in your conception journey.

What is endometriosis?

Endometriosis is an estrogen-dependent inflammatory and immune disease in which there is a growth of endometrial-like tissue that grows outside of the uterus. 

Endometriosis impacts about 5-10% of the female population but unfortunately there has been very little investment or research into understanding endometriosis. As a result, there is still more research needed in this area. 

Current theories as to why endometriosis develops include retrograde menstruation, genetics, toxins, bacteria, hormonal and more. 

Read more about the common drivers of endometriosis.

It is important to make it clear that endometriosis is an immune and inflammatory disease that is influenced by estrogen. Therefore it is not a hormonal condition. 

What are the common symptoms of endometriosis?

Some of the common symptoms of endometriosis include extreme pelvic pain, heavy periods, pain during sex and trouble with fertility. Although research suggests that 20-25% of those with endometriosis will experience no symptoms at all.

Struggling with fertility is extremely common with endometriosis, in fact 30-50% of women with endometriosis can suffer from fertility issues. 

If you are struggling with fertility then it is important to rule out endometriosis as a contributing factor.  

Read about the common symptoms of endometriosis.

How is endometriosis diagnosed?

Unfortunately it can take a long time to receive the correct tests and diagnosis for endometriosis via your GP. The average time to diagnosis in the UK is currently 7.5 years according to a 2020 government report.

If your GP suspects endometriosis from your symptoms they may undertake any or all of the following tests:

  • Pelvic exam
  • Blood tests
  • Urine samples
  • Pelvic ultrasound scan
  • MRI
  • Laparoscopy

Read more about testing, diagnosis and endometriosis.

HOW does endometriosis impact fertility?

Endometriosis can impact fertility in a number of different ways, and the degree to which endometriosis may impact fertility is different for each person. 

If you have stage 1-2 of endometriosis, which is classified as having minimal to no scar tissue damage, then you may not have any problem with fertility. 

Those with stage 3-4 of endometriosis, with endometriotic cysts and implants and scar tissue around the ovaries, uterus, fallopian tubes and rectum may have more difficulty with fertility. 

According to research, while the average couple’s fecundity (potential for conception) is 15-20% per month and decreases with age, in those with endometriosis fecundity is suggested to be 2-10% per month, although this has been debated. 

Here are some of the ways in which endometriosis may be impacting fertility, although more research is needed in this area.

1. Generalised inflammation:

The increased inflammation experienced in endometriosis could be linked to a reduced chance of both the sperm and egg uniting and the embryo implanting. Because inflammation in endometriosis disrupts the normal functioning of the endometrium, this makes it harder for an embryo to implant. 

In addition, we know that inflammation impacts hormone levels. For example inflammation can decrease chances of ovulation and therefore reduce levels of progesterone – both of which are vital for creating and sustaining a healthy pregnancy. 

Inflammation can also increase what is called aromatase activity, which plays a role in the biosynthesis of estrogen. Increased aromatase activity can lead to unopposed or high estrogen which can impact fertility. 

Such inflammation can continue to impact fertility as certain inflammatory cells and markers such as prostaglandins and cytokines can impact the maturation of the oocyte (egg), impact the sperm motility and damage the endometrium as mentioned above. 

Therefore inflammation is a key factor that can impact fertility in endometriosis.

2. Immune system alteration:

The immune system is a big driver of endometriosis. Essentially the innate immune system (the body’s first line of defence against pathogens, viruses and bacteria etc) does not clear up the endometrial tissue as it should. This then allows for gram-negative bacteria to flourish.

In addition, the adaptive immune system often has system abnormalities with the T-cell and B-cells. Research is now linking this abnormal functioning of T and B- cells to being one of the key drivers of endometriosis. 

To put it simply, those with endometriosis seem to have a dysregulated immune response, especially in the peritoneal cavity. This dysregulated immune activity results in increased inflammation and the proliferation of the growth of endometriosis. 

This immune activity can impact the inflammation as mentioned above but it can also impact the ability for a woman to conceive. If antibodies do not recognise sperm or the embryo then it can lead to problems with conception.

3. Structural differences:

There are both structural changes and functional changes that one may experience with endometriosis, including changes to the anatomy of the pelvis, scar tissue of the fallopian tubes, adhesions and more. 

These structural changes can greatly impact the chances of conception and the implantation of the embryo into the uterus lining. 

Specifically there are often structural and functional changes of the endometrium and inner myometrium that can have negative consequences for fertility. This is because these changes impact both implantation and embryo development. 

These structural changes may differ from person to person and therefore it is important to receive individualised and specialised care when trying to conceive with endometriosis. 

4. Hormonal changes:

Alongside the immune system activity, structural changes and inflammation, there are also some hormonal changes and imbalances present that can impact fertility in those with endometriosis. 

Typically in endometriosis there are higher levels of estrogen, this high estrogen in itself can impact fertility and even ovulation. 

It is suspected that those with endometriosis may have genetic changes that impact ovulation and folliculogenesis (which is the process by which the female germ cell develops within the somatic cells of the ovary and matures into a fertilizable egg). Therefore it is still of upmost importance to support hormone levels in those with endometriosis (even if it is not technically a hormonal condition).

5. Egg quality:

Many of the mentioned factors can impact egg quality in endometriosis. For example the presence of scar tissue can impact the blood flow and supply to the ovaries which can impact the quality. Inflammation is one of the biggest contributors to poor egg quality due to increased reactive oxygen species generation and lower antioxidant levels. Inflammation can prevent healthy maturation of oocytes, poor follicular fluid quality, poor development of the embryo and more.

HOW to support fertility and endometriosis

If you’re looking to get pregnant and you have endometriosis, then we recommend working one-on-one with a FUTURE WOMAN practitioner.

Your practitioner will work with you to reduce inflammation, support a balanced immune system, improve egg quality and balance your hormones. As each person is unique, your practitioner will create a highly personalised plan just for you. 

We also recommend testing your hormones at home with our Advanced Hormone Test or Advanced+ with Cycle Mapping Hormone Test when trying to conceive. These comprehensive tests will provide you and your practitioner with a wealth of information about your inflammation, hormone levels, nutrient status, neurotransmitter levels, stress pathways and more.

Read more about testing and endometriosis.

All of our practitioners are experienced in working in conjunction with GPs and can support you alongside your IVF or surgery journeys too.

References:

Brazdova A, Senechal H, Peltre G, Poncet P. Immune Aspects of Female Infertility. Int J Fertil Steril. 2016 Apr-Jun;10(1):1-10. doi: 10.22074/ijfs.2016.4762. Epub 2016 Apr 5. PMID: 27123194; PMCID: PMC4845518.

Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010 Aug;27(8):441-7. doi: 10.1007/s10815-010-9436-1. Epub 2010 Jun 25. PMID: 20574791; PMCID: PMC2941592.

Filip L, Duică F, Prădatu A, Crețoiu D, Suciu N, Crețoiu SM, Predescu DV, Varlas VN, Voinea SC. Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches. Medicina (Kaunas). 2020 Sep 9;56(9):460. doi: 10.3390/medicina56090460. PMID: 32916976; PMCID: PMC7559069.

 

Mohammed Rasheed HA, Hamid P. Inflammation to Infertility: Panoramic View on Endometriosis. Cureus. 2020 Nov 16;12(11):e11516. doi: 10.7759/cureus.11516. PMID: 33354460; PMCID: PMC7746006.

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