Written by: Lauren Chamberlain
Edited and Reviewed By: Anabelle Clebaner MS, RDN
Dealing with endometriosis is already a challenge—pain, fatigue, and the frustratingly long journey to diagnosis. But for many, one of the hardest realities to face is how this condition might impact fertility. Whether you’re actively trying to conceive or simply thinking about the future, it’s natural to wonder: Will I be able to get pregnant? Will it take longer? Am I at risk for complications?
Let’s break it down—why does endometriosis make conception more difficult? And what can be done to improve fertility outcomes?
Studies suggest that up to 50% of people with endometriosis may experience fertility challenges, and about half of those diagnosed with infertility have underlying endometriosis. However, a diagnosis doesn’t mean pregnancy is impossible! It may take longer, require medical support, or necessitate lifestyle adjustments—but many people with endometriosis go on to conceive and carry healthy pregnancies.
Now that we’ve covered the statistics, let’s explore why endometriosis affects fertility in the first place.
Endometriosis is a complex condition where tissue similar to the uterine lining grows outside the uterus, leading to inflammation, scarring, and hormonal imbalances. These factors can contribute to fertility struggles in multiple ways:
Endometriosis is associated with chronic inflammation, which plays a key role in fertility challenges. The condition causes an increase in inflammatory cytokines—proteins that regulate immune responses. These cytokines can interfere with ovulation, fertilization, and implantation by creating a hostile uterine environment. Chronic inflammation may also impair the function of the corpus luteum, the structure responsible for producing progesterone after ovulation. Since progesterone is critical for preparing the uterine lining for implantation, low levels may result in implantation failure or early miscarriage.
Additionally, endometriosis is often linked to estrogen dominance. Excess estrogen can thicken the endometrial lining abnormally, disrupt the menstrual cycle, and contribute to a suboptimal hormonal balance for conception.
Endometriosis has been linked to oxidative stress, a condition where an excess of reactive oxygen species (ROS) damages cellular structures, including eggs. This oxidative damage can lead to:
Research suggests that targeted nutritional strategies, such as increasing antioxidant intake (e.g., vitamin C, vitamin E, and CoQ10), can help mitigate oxidative stress and improve egg quality.
Many individuals with endometriosis develop ovarian cysts known as endometriomas. These cysts, filled with old blood, can impact ovarian function in several ways:
Endometriosis can cause adhesions—bands of fibrous scar tissue that develop between organs. These adhesions may:
For those with significant tubal damage, natural conception may be challenging, and assisted reproductive technologies like IVF may be necessary.
Successful pregnancy depends on a fertilized egg implanting into a healthy uterine lining. Endometriosis can interfere with this process due to:
While many individuals with endometriosis achieve healthy pregnancies, it’s important to be aware of potential risks and considerations:
Studies have identified a higher incidence of certain complications in pregnant individuals with endometriosis:
These findings underscore the importance of vigilant prenatal care for individuals with endometriosis to monitor and manage potential complications effectively.
Surgical interventions for endometriosis, such as laparoscopic excision, aim to alleviate symptoms and improve fertility. However, the effects of surgery on pregnancy outcomes are complex:
Therefore, surgical decisions should be individualized, weighing the benefits against potential risks, and discussed thoroughly with a healthcare provider.
Given the potential challenges associated with endometriosis and pregnancy, preconception counseling is highly recommended. This process involves:
Engaging in preconception counseling allows for informed decision-making and the development of a tailored care plan to optimize pregnancy outcomes.
Adopting specific dietary and lifestyle changes can positively influence fertility and pregnancy outcomes in individuals with endometriosis:
Implementing these modifications can support reproductive health and may increase the likelihood of a successful pregnancy.
For those experiencing difficulty conceiving naturally, ART options such as in vitro fertilization (IVF) may be considered. While endometriosis can impact the success rates of ART, individualized treatment protocols and close monitoring can enhance outcomes. Consulting with a fertility specialist can provide personalized guidance on the most appropriate interventions.
Ultimately, while endometriosis can pose challenges to conception and pregnancy, understanding the potential risks and proactively managing them with a healthcare team can lead to successful outcomes.
If you have endometriosis and are concerned about your fertility, there are steps you can take to optimize your chances of conception:
Endometriosis may make conception more challenging, but it doesn’t mean it’s out of reach. Every fertility journey is different, and while endometriosis can present obstacles, there are many ways to take control of your reproductive health. Whether through lifestyle changes, medical treatments, or working with a specialist, you have options. If you’re struggling, reach out to a healthcare provider to explore the best path for you. Knowledge is power, and by understanding the impact of this condition, you can approach your fertility journey with confidence and clarity.
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC9983692
https://pmc.ncbi.nlm.nih.gov/articles/PMC8224039
https://www.rbmojournal.com/article/S1472-6483(13)00007-2/fulltext
https://pmc.ncbi.nlm.nih.gov/articles/PMC8065992
https://pmc.ncbi.nlm.nih.gov/articles/PMC7226034
https://pmc.ncbi.nlm.nih.gov/articles/PMC9528818
https://pmc.ncbi.nlm.nih.gov/articles/PMC10058497/#sec5-life-13-00654
https://pmc.ncbi.nlm.nih.gov/articles/PMC10820275
Then you need to learn about Choline! Choline is just as important in helping to prevent neural tube defects as the well known vitamin folate, but unfortunately, it’s not as well known or spoken about. If you’re looking for some choline rich foods for fertility, then read on!
The research that has been done over the past 20 years, outlines very clearly the benefits of choline when it comes to both overall health during pregnancy and the development of our babies brain.
Studies on animal models have shown that Choline plays a key role in enhancing brain function and also serves to protect the brain and its various elements as it develops.
Human studies on the other hand have shown that taking Choline in doses higher than what is currently recommended by various health bodies, has multiple benefits, including:
Why haven’t you heard of Choline before?
Unfortunately, the research around Choline is relatively new in scientific terms (by this I mean the research has only really been looking into this topic for the past 20 years), and it’s not a well known supplement when it comes to fertility (well outside of the dietetic community anyway!).
The evidence while not well known, is really promising and it is well worth aiming to include more sources of choline in your diet if you are trying to conceive or pregnant.
So where do you find Choline?
Choline is found in the highest amounts in animal products.
Like many other nutrients, our choline needs increase dramatically during pregnancy with some studies suggesting that our choline needs may be almost double what is currently recommended by the guidelines.
Unfortunately, many of us don’t currently get our choline needs from food alone, and in these cases a supplement may be of benefit to support a healthy pregnancy. Not all prenatal supplements contain Choline, and some also don’t contain enough to provide you with all the benefits. Some of my favorite prenatals that include adequate choline are FullWell Prenatal and Needed.
If you’re already taking a prenatal that doesn’t have choline, consider supplementing or assessing your diet to see if you meet the choline requirements for adequate fertility and pregnancy. You can find more fertility supportive supplements in my fertility dispensary here. Remember, it’s important to ensure that you work with a professional when selecting the right prenatal supplements for you!
Looking for more 1-on-1 support on your fertility journey? Apply for a free 20 minute strategy call today. I can help you regulate your cycles, ovulate, and have a healthy pregnancy using my proven functional nutrition method. I look forward to speaking with you!
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