What is endometriosis?

Endometriosis is an inflammatory condition that affects 1.5 million women in the UK and is the second most common gynaecological condition.

Endometriosis is a medical condition where the endometrial tissue, lining the uterus (endometrium) grows outside of the uterus. It can range from mild endometriosis to the more severe type. The growth of this endometrial-like tissue in the uterus leads to the formation of adhesions, otherwise known as scar tissue. Too much build-up of this abnormal tissue can then cause the reproductive organs and other structures within the pelvic cavity to stick together.

This can lead to pelvic pain, heavy periods and painful periods, and potential fertility challenges. These are a few of the common symptoms associated with endometriosis. 

What factors contribute to the challenges of conceiving with endometriosis?

Almost 40% of women struggling with fertility issues have endometriosis. Endometriosis can increase a person's risk of miscarriage and having an ectopic pregnancy or premature birth. There are several reasons why people with endometriosis may struggle with conception, including:

1. Distorted anatomy: The presence of endometrial tissue outside the uterus can cause adhesions, scar tissue, and structural abnormalities in the reproductive organs, such as endometriosis lesions and endometriomas (chocolate cysts) on the ovaries. These can interfere with the normal function of the ovaries, fallopian tubes, and uterus, making it difficult for the sperm to meet the egg or for the fertilized egg to implant into the uterine lining and develop properly.
2. Hormonal imbalances: Endometriosis is associated with hormonal imbalances, specifically increased levels of estrogen. Imbalances in the reproductive hormones estrogen and progesterone can affect the ovulation process, disrupting the release of mature eggs and making conception more challenging.
3. Inflammation and immune system dysfunction: Endometriosis is characterised by inflammation in the pelvic region. This chronic inflammation can impact fertility by interfering with the release of eggs, damaging sperm, and impairing the function of the fallopian tubes and uterus. Additionally, endometriosis is associated with immune system dysfunction, which may affect fertility.
4. Ovarian reserve and egg quality: Endometriosis can potentially reduce the ovarian reserve, which refers to the number and quality of eggs remaining in the ovaries. The condition may lead to the depletion of eggs at a faster rate or reduce the quality of the available eggs, affecting the chances of successful fertilization.
5. Pain during sex: The severe pain and discomfort associated with endometriosis can make sexual intercourse unpleasant or even painful, reducing the frequency of attempts to conceive.

How can you have a natural pregnancy with endometriosis?

First things first, when we say natural pregnancy, we're talking about getting pregnancy without fertility treatment or assisted reproductive technology. A natural pregnancy happens from sexual intercourse, where sperm is ejaculated into the vagina. The sperm fertilises an egg to create an embryo, and this embryo implants in the womb.

While many people will want to turn to medical treatments for endometriosis, like laparoscopic surgery, to help their endometriosis symptoms and improve their chances of conception, laparoscopic surgery has the potential to negatively impact both your egg quality and quantity.

While natural conception can be made more difficult with endometriosis (and this shouldn't be undermined!), having a natural and healthy pregnancy is still possible for lots of patients with endometriosis. Here are a few suggestions that may increase your chances:

1. Consult a healthcare professional: Start by consulting with a healthcare provider who specialises in fertility or endometriosis. They can assess the severity of your condition, offer personalised advice, and guide you through the process. At Fertifa, we have experts on our clinical team who are specialists in women's health issues like endometriosis.
2. Manage your symptoms: Proper management of endometriosis symptoms can help create a more conducive environment for conception. Follow your healthcare provider's recommendations for pain management and treatment options to keep symptoms under control.
3. Track your menstrual cycle: Monitoring your menstrual cycle can help you determine the most fertile days for conception. Use ovulation prediction kits, track basal body temperature, or monitor changes in cervical mucus to identify the best time for intercourse.
4. Maintain a healthy lifestyle: Focus on maintaining a healthy lifestyle by following a balanced diet, exercising regularly, and managing stress. Adequate nutrition and implementing different physical activities can positively impact fertility.
5. Have regular intercourse: Engage in regular sexual intercourse, especially during your fertile window. Aim to have intercourse every two to three days throughout your cycle, but especially during the days when you are most likely to ovulate.
6. Consider fertility treatments: If you're having difficulty conceiving naturally, fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) may be options to explore. The effectiveness of the treatment depends on what stage of endometriosis the patient has. Although IVF success rates negativley correspond as the severity of the condition increases, women with stage three and four, moderate/severe endometriosis, still saw their pregnancy rates increase with IVF. Generally, these treatments can increase the chances of pregnancy by bypassing some of the challenges posed by endometriosis. If this is a path you are considering, make sure you speak with a fertility specialist to discuss what treatment is right for you.

Remember, women with endometriosis can get pregnant!

Each person's situation is unique, and what works for one person may not work for another. Remember that your success rate with conception will vary depending on how severe the condition is, as there are multiple stages of endometriosis. In fact, it's been shown that women with mild to moderate endometriosis actually have pregnancy rates similar to those without endometriosis.

It's important to work closely with your healthcare provider, Fertifa doctor, or endometriosis specialist to develop a personalised plan that suits your specific needs and circumstances. If you have any questions about anything in this article or if you're thinking of beginning your fertility journey, speak with your Fertifa Patient Advisor. We are always here to help 💜