Can You Get Pregnant With Endometriosis?

Infertility With Endometriosis Does Not Have to Be Permanent

• Endometriosis and Infertility|
• Addressing the Root Cause of Endometriosis|
• How to Improve Endometriosis Naturally|
• Surgical and Hormonal Treatment Options|
• Pregnancy With Endometriosis Is Possible|

Endometriosis is well-known for causing symptoms like abdominal pain and gastrointestinal dysfunction. However, it can also be a silent illness. For many women, they don’t know they have endometriosis until they’re undergoing clinical evaluation for infertility [1]. One study found that infertility is the most common symptom for women with endometriosis, affecting 90% of those with the condition [2].

Does this mean that you can’t get pregnant with endometriosis? No, but you do have to address the symptoms and ideally, the underlying causes of your endometriosis, including inadequate nutrition, gut and hormone imbalances, or too much stress. Addressing these issues and reducing endometriosis symptoms may improve fertility.

Beyond that, there are surgical and hormonal treatment options to address infertility, including IVF. Sometimes these are still the most successful routes even after you’ve done everything you can to address endometriosis naturally, and that’s okay.

Endometriosis and Infertility

Infertility affects 90% of women with endometriosis and remains the most common symptom of the condition [2].

It’s assumed that this effect of endometriosis is caused by endometrial tissue implanting in the ovaries, where cysts called endometrioma can form. This can also result in:

• Pelvic pain
• Bloating
• Constipation
• Painful bowel movements
• Painful intercourse
• Painful menstruation
• ​​Irregular menstrual cycle
• Adhesions (which can lead to scar tissue development)
• And other symptoms (which may also affect fertility)

Symptoms can vary between mild endometriosis and severe endometriosis, which will also affect the treatment path taken. For example, if you’re experiencing multiple lesions and extreme pain, a surgical procedure may be recommended right away. (Not that this is your only option).

Overall, medical (hormone treatment options) and surgical treatments are most commonly used to address endometriosis-related infertility.

While we don’t have much evidence around alternative and natural treatment options yet, some studies have looked at the effects of Chinese herbal medicines and dietary interventions on infertility.

We can also infer that calming down the nervous system by reducing stress and improving gut health will have a positive effect on fertility and symptoms of endometriosis in general (creating a space of safety and security in the body for new life). We will address the different treatment options more in depth below.

Addressing the Root Cause of Your Endometriosis

On a surface level, endometriosis is assumed to be caused by a backward movement of menstrual flow. The endometrium is the innermost layer of the uterus, and shedding the lining of this layer is what causes menstruation. 

Most commonly, this tissue implants in the ovaries, forming endometrioma — blood-filled cysts. These then cause symptoms like pelvic pain and infertility [3]. Endometriosis can also affect other parts of the reproductive organs like the fallopian tubes, and less commonly, the large intestine (bowel endometriosis) and central nervous system.

But to make endometrial tissue in the first place, the body needs the hormone estrogen. This is why many women with endometriosis have high estrogen levels (and often consequently, low progesterone levels) [4].

Progesterone is the female sex hormone associated with pregnancy, so if the body isn’t adequately producing or using progesterone, pregnancy will not occur [5].

In addition to hormone imbalances, oxidative stress, too many free radicals, inflammation, epigenetics (the interaction between your environment and gene expression), and an unhealthy environment are other potential endometriosis causes or increased risk factors. It’s likely that more than one cause will need to be addressed for many women.

Working with a knowledgeable healthcare practitioner who can take a detailed medical history and evaluate you for each of these factors can help you outline a fertility treatment plan with the best chance of success.

How to Improve Endometriosis Infertility Naturally 

Treating endometriosis naturally may help women improve their fertility and reduce other endometriosis symptoms like pain and gastrointestinal irregularities.

Chinese Herbal Medicine

A few studies have been done on certain Chinese herbal medicines for treatment of infertility.

For example, a systematic review and meta-analysis involving 936 patients examined the safety and effectiveness of Bushen Huoxue, a common prescription in Chinese herbal medicine, for the treatment of endometriosis-related fertility issues. The results showed that use of Bushen Huoxue was associated with significantly higher pregnancy rates than conventional hormone therapy [6].

Another 2021 review showed that patients who were treated with both Chinese herbal medicine and conventional treatment (either medication or surgery) over two to six months had a significantly higher pregnancy rate than those who received conventional treatment alone [7]. Negative side effects didn’t differ significantly between groups, suggesting that Chinese herbal medicine is safe for endometriosis patients with fertility issues.

A third literature review looked at 82 women who had endometriosis and difficulty getting pregnant, and who were preparing to undergo IVF. The women were randomly assigned to receive Chinese herbal medicine for three months or no treatment for three months. The results showed that the Chinese herbal medicine group had a higher pregnancy rate and healthier embryos than the control group following IVF [8].

From these studies, among others, Chinese herbal medicine appears to be safe and effective for women undergoing various therapies to address infertility, either as a complementary or standalone treatment.

Gut Health

Gut health may also have a significant impact on endometriosis and vice versa. Research shows that women with endometriosis have less diverse gut microbiota [9], and endometriosis may be characterized by chronic low-grade inflammation, dysbiosis or abnormalities in the gut microbiome, and leaky gut [10]. Dysbiosis may also contribute to disrupting estrogen levels, which is a potential cause of endometriosis [11].

Since gut dysbiosis is common in endometriosis, and dysbiosis can contribute to hormonal imbalance and inflammation — which are connected to infertility in endometriosis — you may be able to get to the root cause of the problem by focusing on improving the health of your gut microbiome. Interventions to improve gut health and encourage pregnancy may include: 

• Lowering gut inflammation with a healthy, nutrient-dense diet
• Improving nutrient absorption with supplemental digestive enzymes or stomach acid if needed
• Recalibrating the microbiota and pruning out unhelpful microbes with probiotics. 

Stress

Stress is another huge factor that plays a role in infertility and endometriosis. Understandably, trying to reverse infertility may feel stressful, but it’s extremely important that the body is in a low-stress state in order for ovulation and pregnancy to occur. Your nervous system needs to sense that your body is a safe environment in which to grow new life. 

Practices like meditation, yoga, and breathing exercises have all been scientifically proven to help reduce stress and improve feelings of well-being, especially during challenging times [12, 13, 14].

Pelvic Floor Dysfunction

Another area to investigate when addressing endo and infertility is pelvic floor dysfunction. Pelvic floor specialist Jandra Mueller explained on an episode of Dr. Ruscio Radio that around 90% of women with endometriosis likely also have some kind of pelvic floor dysfunction, where the pelvic floor muscles become too weak, too strong, or uncoordinated. 

Pelvic floor dysfunction can cause bowel and bladder issues, and it can also impact sexual function. Whether you’re taking a natural or more conventional medical approach to addressing infertility with endometriosis, it’s worth getting evaluated by a pelvic floor specialist to assess your pelvic floor muscles and how they may be impacting your fertility. 

Diet

There’s a decent amount of research showing that diets like the Mediterranean diet, a gluten-free diet, and a low FODMAP diet improved symptoms in women with endometriosis. These improvements included decreased pain, improved GI response, and better overall well-being [15].

As far as specific dietary choices go, some studies show that certain nutrients and foods may help prevent endometriosis, like: 

• Omega-3 fatty acids [16]
• Dairy [17]
• Vitamin D [18]
• Phytoestrogens (plant compounds that mimic estrogen, and have been shown to exert anti-estrogen effects in endometriosis) [19]

However, everyone’s nutrient status and food tolerances are different, so it’s important to work with a qualified practitioner to evaluate your personal nutrient needs. For instance, dairy can trigger inflammation if you have a known dairy sensitivity, so this is an area where you should make sure to listen to your body. These nutrients were also not associated with endometriosis treatment, only possible prevention of the condition.

Surgical and Hormonal Treatment Options for Endometriosis-Related Infertility

If you’ve tried everything you can to fix endometriosis-related infertility naturally and you’re still experiencing fertility issues, there are surgical and hormonal treatment options available, including IVF (in vitro fertilization).

Using these treatment options does not mean you’ve failed; for many women, treatments like IVF are the best and most successful option available for endometriosis-related infertility [20].

A literature review looked at three options for endometriosis-associated infertility [20]:

• Medical treatment
• Surgery 
• Technologies for assisted reproduction

The medication clomiphene citrate is the most widely used medical treatment (either alone or combined with gonadotropins) to improve fertility [20].

Surgical treatment typically means laparoscopy to remove endometriotic nodules and endometriomas, and restore normal pelvic anatomy. Laparoscopy costs less and requires shorter recovery and hospitalization times than laparotomy or robotic surgery.

Assisted reproductive technologies include:

• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection

Of these options, the review concluded that IVF had the highest pregnancy success rates for infertile women who have endometriosis.

However, another systematic review and meta-analysis studying 2,245 women with endometriosis-related infertility showed that, compared to placebo, laparoscopic surgery alone or GnRH agonist drugs alone resulted in the greatest chance of getting pregnant [21].

Surgical laparoscopy alone increased the odds of getting pregnant by 63% vs. placebo, while GnRH agonist drugs increased the odds of getting pregnant by 68% vs. placebo. GnRH agonist drugs suppress the production of sex hormones. In cases of endometriosis where the body is overproducing estrogen, this can improve symptoms, including infertility. 

However, neither of these studies report on the live birth rates and miscarriages, so more high-quality research is needed on these outcomes. 

The important thing to note is that you have several options available, and there’s no right or wrong answer. With the guidance of your fertility specialist, it comes down to choosing what is the best option for you and your unique health situation. 

Can You Get Pregnant With Endometriosis? Yes, It’s Possible 

Overall, we need more clinical trials to understand how to achieve pregnancy with endometriosis. However, endometriosis may be improved naturally with dietary changes, lifestyle modification to reduce stress, hormone balancing, and strengthening gut health. Alongside some Chinese herbal treatments, these strategies may help improve fertility and increase the chances of pregnancy occurring. 

Otherwise, medical, surgical, and assisted reproductive technologies are also available, and these options are successful for many women. 

If you’re looking for a functional medicine practitioner to guide you on your fertility journey with endometriosis, reach out to us to schedule a consultation at the Ruscio Institute for Functional Medicine.

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