Endometriosis is a condition that affects one in nine women globally. This number is thought to be higher when we include the experiences of gender diverse people, and those who remain undiagnosed. For those who receive a diagnosis of endometriosis, it can be a time of questions, and uncertainty. The most common questions are “what is the impact on fertility, and how can I get pregnant?”
In this blog, I aim to answer both of these questions, but first let’s discuss, what is endometriosis?
What is endometriosis?
Endometriosis is both a progressive and chronic condition. Endometriosis is when endometrial like tissue is found outside the uterus. This tissue can be found on the ovaries, fallopian tubes, bowel, around the uterus and abdominal wall.
The most common symptoms of endometriosis are
- Pain, either during menstruation or/and throughout the cycle
- Pain with sexual intercourse, either upon entry and/or deep penetrating pain
- Heavy menstrual bleeding, either regular or irregular
- Bladder and bowel issues
How does endometriosis affect pregnancy?
Endometriosis impacts ability to fall pregnant in multiple ways. Egg quality is decreased in those with endometriosis, due to increased levels of inflammation in the pelvic region. This inflammation can damage the eggs that reside in your ovaries. Inflammation in the pelvic region caused by conditions such as endometriosis or adenomyosis, can also decrease the chances of a successful implantation. Due to endometrial growths or endometriomas, it can be difficult for eggs to successfully exit the ovaries, and travel through the fallopian tubes. This damage can occur to the ovaries, impacting ovarian reserve.
Can you get pregnant with endometriosis?
Once we understand how endometriosis impacts fertility, it is only natural to wonder how endometriosis may impact pregnancy, and ability to hold a pregnancy to term. Most people who have endometriosis are able to have a normal, and uncomplicated pregnancy. The research in this area of endometriosis and pregnancy outcome, is far more limited, and there is less understood around the how and why.
Some research states there is no increased risk of complications. Other research notes there is an increased risk of miscarriage, ectopic pregnancy, preterm birth, placenta previa and excess bleeding. Postpartum, some women with endometriosis find that symptoms improve or go away. These symptoms may come back once people stop breastfeeding and periods return.
Can Endometriosis Cause Miscarriage?
The research isn’t clear on whether having endometriosis necessarily increases the risk of miscarriage. However, those with untreated endometriosis are more likely to experience recurrent implantation failure.
Chances of getting pregnant with endometriosis
Up to half of all those who have endometriosis will encounter trouble falling pregnant (30-50%) and half of people who experience troubles with fertility, will be diagnosed with endometriosis. With the amazing advancements in science, and modern reproductive technologies, many people with endometriosis are able to make their dreams of having a family, come true. The research is strong in indicating that those who receive treatment for endometriosis, or who have well managed endometriosis, are more likely to have improved pregnancy rates. This is through natural conception or via assisted reproductive technologies (ART).
How to get pregnant with endometriosis
One of the key ways to increase chances of conception with endometriosis, is to seek treatment for endometriosis. Some of these include:
- Medical Treatment (Over-the-counter/Hormonal treatments)
These are things such as the combined oral contraceptive pill, the Mirena IUD/progestogens, and GnRH. All of these treatments aim to improve quality of life. They all assist with reducing pelvic pain (throughout the menstrual cycle), slowing growth of endometrial cells, and reducing heavy bleeding. Whilst these are useful to manage endometriosis, they cannot be used to fall pregnant as they are contraceptives. Doctors or gynaecologists may recommend you stay on your hormonal treatment until you are ready to conceive.
- Assisted reproductive technologies (ART)
For those who have been on the TTC (trying to conceive) journey for 6 months to a year, the next step might be ART. This might be IUI (intrauterine insemination), or IVF (invitro fertilisation). The next steps will be decided by a fertility specialist and their patients with endometriosis. It is important to note that not everyone who has endometriosis will need fertility treatment.
- Laparoscopic excision surgery
Laparoscopy with excision surgery is the “gold standard” of endometriosis treatment. During a laparoscopy, a very thin tube is inserted via small cuts on the abdomen to access the abdominal space. During this time, a gynaecologist can diagnose endometriosis and perform excision surgery if needed. After laparoscopy, women with endometriosis may have an increased chance of falling pregnant within 6 months of surgery. It is important that endometriosis is removed as completely, and as best as possible. Scarring because of incorrect endometriosis removal, can contribute to endometriosis regrowth, and further impact fertility.
- Lifestyle changes
The overload of appointments, and medications can be overwhelming and some people with endometriosis may like to use other management strategies. These are often referred to as non-pharmacological strategies, or lifestyle therapies. These may be used in combination with the above treatments to increase chances of pregnancy.
Lifestyle changes are often used in conjunction with medical management, to optimise quality of life for those who live with endometriosis. This can also apply to improving fertility, and chances of a successful pregnancy.
4 ways to naturally boost your fertility with endometriosis
Many of the impacts of endometriosis on fertility can be helped with the aid of diet. Many of the same principles that endometriosis nutrition centres on, is also important and applicable to increasing fertility.
1. Omega-3 fats
The absolute star when it comes to fertility and endo nutrition, omega-3 fatty acids are non-negotiables in an endo fertility diet. Omega 3’s play a key role in protecting uterine lining and egg quality. Research has shown that omega-3 intake plays a role in reducing inflammatory markers in the body. This is key in improving endometriosis severity, and improving fertility. Omega-3 fatty acids are most abundant in oily fish such as salmon, sardines, trout, and anchovies. Omega-3’s are also found in chia seeds, flaxseeds and walnuts.
2. Vitamin E
Another beautiful nourishing nutrient! Vitamin E is shown to reduce pain across the menstrual cycle. Research also showed that women with endometriosis had a lower intake of antioxidants in comparison to those without endometriosis. When a high antioxidant diet was consumed, women with endometriosis had decreased oxidative stress markers (pro-inflammatory markers). Theoretically, having decreased inflammatory markers, should improve rates of pregnancy.
3. Increase intake of fruit and vegetables
Fruits and vegetables are full of antioxidants. Antioxidants are a key component of an endometriosis fertility diet. This follows the general principles of anti-inflammatory eating. Antioxidants protect our body cells (including our eggs) from damage, and can counteract inflammatory effects of endometriosis. Research has also shown that women who had an increased intake of fruit, particularly citrus fruits, had a lower risk of endometriosis. This is likely due to the antioxidant effects of vitamin C that is found in abundance in fruits and vegetables.
4. Build your team
The last thing that you should include, is to build your team. Take time to find a GP and gynaecologist who hears you and validates your concerns. As well as having an allied health team who advocates for you (e.g. pelvic floor physiotherapist, fertility specialist, psychologist or pain psychologist etc)
Book a consult today and manage your fertility with endometriosis.
If you would like help getting your body ready for pregnancy with endometriosis, book a ‘Discover’ package here.
