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The Link between Endometriosis and Infertility.
Endometriosis is thought to be part of the picture for a significant proportion of people struggling with infertility. Some sources say that up to 40% of cases of unexplained infertility are associated with endometriosis.
That is a frightening statistic for anyone recently diagnosed with endometriosis, so here is another statistic that shines a different light. Around 60-70% of people with endometriosis are thought to be able to get pregnant naturally and spontaneously [1].
You may have read that endometriosis increases your risk of early loss. It does, statistically it takes it from 1 in 5 pregnancies are lost early by people without endometriosis and 1 in 4 are lost early by people with endometriosis, but good holistic preconception support can help to improve the odds.
Those statistics paint a very confusing picture and to understand how your diagnosis of endometriosis is likely to impact your chance of natural conception and healthy pregnancy, you have to look beyond the diagnosis.
How Does Endometriosis Impact Fertility? (and what you can do about it!)
Inflammation
Endometriosis is often associated with pain and inflammation. This can have a significant impact on egg quality, hormone regulation and potential for natural conception. But there are lots of things you can do to minimise the inflammation which will in turn improve egg quality, support hormone regulation and encourage natural conception. Acupuncture has a very good reputation for having a positive impact on pain and inflammation (randomised control trial data is now available to confirm that the impact we see in clinic is as expected [2].). Functional nutrition is incredibly useful for tackling inflammation.
Acupuncture
Chinese Herbs
Functional Nutrition - targeted supplements and diet (eg, data shows that a high dose of N acetyl cysteine may be helpful to reduce inflammation and pain and improve fertility for endometriosis clients [3]).
Poor Circulation
One of the impacts of inflammation is the impact it has on the microcirculation within the ovaries that is so essential for healthy follicle development.
Acupuncture
Moxa
Visceral osteopathy (this is an essential part of any decent treatment plan for endometriosis - I am lucky enough to work with Gill and find her input invaluable for tackling the internal adhesions, inflammation, stagnation and poor fluid circulation that we see in clients with endometriosis).
From a self-help perspective, look at castor seed oil packs and gentle womb massage.
Nutrient Deficiencies
There are several nutrient deficiencies that are associated with the chronic inflammatory state of endometriosis - zinc, magnesium, iron, vitamin D, vitamin B12 to name but a few. Endometriosis is also often associated with horrendously heavy, long periods which deplete the system further. All these nutrients are essential for healthy fertility, good egg quality and a healthy, receptive lining. If budget allows, I will always encourage my clients to engage with a functional nutritionist to get bespoke, personalised assessment and guidance for supplement regimes - too much or too little of so many nutrients can negatively impact fertility.
Functional Nutrition
Low AMH
This is often part of the picture with endometriosis because of all of the above. Inflammation creates a toxic environment for the growing follicles, poor circulation and microcirculation to/from and within the ovaries starves the growing follicles of nutrients, and often the blood itself is nutrient poor. These all combine to create an environment that does not support healthy follicle growth, but in many cases we can make such improvements to the internal environment that AMH goes up significantly.
Microbiome Issues
The hormone patterns and inflammation associated with endometriosis can encourage the microbiome to shift into an unhealthy state as it can encourage the growth of microbes that we associate with an increased risk of infertility and early loss. Some of these microbes are also known to have a negative impact on sperm health. I will always encourage our endometriosis clients to engage with vaginal and semen microbiome testing.
Microbiome testing (vagina, semen and potentially uterine).
Immune System Issues
A well functioning immune system is an important part of implantation and early pregnancy, and for some people, endometriosis can raise the risk of their immune system being so dysfunctional that it may prevent implantation or trigger early loss. If I suspect that is the case, I would refer you to a Reproductive Immunologist for a NK cell test.
Acupuncture can help to stabilise a slightly disordered immune system.
Chinese Herbs can also help to stabilise a slightly disordered immune system.
Microbiome testing is essential because chronic infection can dysregulate the immune system.
Male Fertility
You may be asking yourself why I have added Male Fertility to the list of ways that endometriosis can impact fertility. This is because almost without exception, I have clients come to me with endometriosis who have been told that it is the cause of their infertility, without proper evaluation of male fertility. And I have had cases before where we have made significant improvements to endometriosis, and then found that the remaining stumbling block was raised sperm DNA fragmentation or semen microbiome issues. I strongly advocate to properly assess male fertility rather than put all the blame at the door of endometriosis.
How To Tackle Infertility with Endometriosis.
Firstly, you need to realise that most people with endometriosis are able to achieve a healthy, natural pregnancy. Endometriosis comes with its unique challenges, but if you understand the landscape it is usually possible to achieve a good outcome for clients with endometriosis.
Secondly, there is a world of difference between the impact of angry, inflamed, painful endometriosis in a system struggling with nutrient deficiencies and the impact of calm, quiet endometriosis in a system nutritionally replete.
Thirdly, don't forget that most people with endometriosis conceive naturally, and spontaneously - do don't overlook a thorough assessment of male fertility as that could be the limiting factor.
Most importantly - reach out for expert, holistic support because it can make a world of difference to infertility with endometriosis.
https://www.endometriosis-uk.org/endometriosis-fertility-and-pregnancy
Li PS, Peng XM, Niu XX, et al. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril. 2023;119(5):815-823. doi:10.1016/j.fertnstert.2023.01.034
Anastasi E, Scaramuzzino S, Viscardi MF, et al. Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes. Int J Environ Res Public Health. 2023;20(6):4686. Published 2023 Mar 7. doi:10.3390/ijerph20064686