Endometriosis impacts around 1 in 10 women of menstruating age and one-third to one-half of those women will struggle with infertility – about twice the rate of infertility of the general population. 

 If you know you have endometriosis, or suspect it (painful periods, painful intercourse and pain when having a bowel movement are key signs), understanding the impact endometriosis may have on your current and future fertility is important.  Being empowered by knowledge can give you hope – hope to end the pain and suffering of endometriosis, and hope to overcome the pain and suffering of infertility.

Endometriosis and the Immune System

One of the most important features of endometriosis is the changes in the immune system that are found in women with endo (more on that here).

Notably, a huge number of inflammatory prostaglandins are produced in the endo lesions of endometriosis.  In our reproductive system specifically, prostaglandins contribute to local inflammation and contraction of smooth muscle leading to cramping. Altogether, the actions of prostaglandins create a less than ideal environment not only for our menstrual cycle, but for sperm as well.

 Another key finding in the immune function of women with endometriosis is a higher than normal number of macrophages. Macrophages are another type of immune cell that searches for and consumes foreign cells, normally viruses and bacteria. Do you know what else a macrophage may identify as a foreign cell? Sperm and embryos. The high levels of circulating macrophages can interfere with normal conception processes and impact fertility.

Endometriosis, Ovaries and Ovulation

Two out of three women with endometriosis will have endometriomas – endometriosis on the ovaries. These endometriomas lead to the formation of blood-filled “chocolate” cysts on the ovaries – so named because of their characteristic colour and texture.

When endometriosis impacts the ovaries the overall health of the ovary is affected, blood flow may be altered; inflammation and hormonal changes are common. The health of the ovary is not the only concern, but egg growth, development and release are also affected. Women with endometriosis have increased rates of luteinized, unruptured follicle syndrome (LUFS) – a condition further exacerbated by the use of NSAID pain relievers for pain management in endometriosis. If you combine the impacts of endometriosis on ovarian health with other factors, such as increasing age, which also is detrimental to ovarian health, you can understand why there are issues with fertility.

Endometriosis and the Fallopian Tubes

When endometriosis occurs in the fallopian tubes scar tissue can form and create an obstruction that interferes with the ability of sperm to reach the egg, or for a fertilized egg to travel to the uterus. This physical blockage significantly reduces fertility and can also explain the increased incidence of ectopic (outside the uterus) pregnancy in women with endometriosis.

 Additionally, the production of prostaglandins (inflammatory particles) that are produced by endometrial lesions can cause spasms in the fallopian tubes. When this occurs a fertilized egg can be pushed to the uterus so quickly that the endometrium does not have enough time to prepare for a healthy implantation. This may result in no implantation, early miscarriage or possibly premature labour.

In one of the great injustices in the world, women with endometriosis have a risk of miscarriage that is 3 times greater than other women.

Endometriosis and the Uterus

Endometriosis can also invade the muscular wall of the uterus, a condition known as adenomyosis. This can cause scar tissue to develop in the uterus, causing difficulty for successful implantation of the fertilized embryo. And if implantation does occur, adenomyosis can keep your baby from growing properly within the uterus, resulting in a dramatically increased risk of early and late miscarriage in women with endometriosis.

There Is Hope

Knowledge is empowering, but it can also be overwhelming.  But don’t lose hope, there are many lifestyle changes, supportive supplements and naturopathic treatments that can be used to manage endometriosis and improve your chances of a healthy pregnancy. What’s even more promising is that many of the lifestyle changes and supplements used to manage endometriosis are safe during fertility treatments. It’s important to consult a licensed and experienced Naturopathic Doctor to support and individualize your care.  You aren’t alone in this. 

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collete. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Dr. Lisa Watson delivers health care that supports balanced and attainable health at all ages and stages of life. Of primary importance is health care that nurtures the body, mind, spirit, family and community. As a Naturopathic Doctor and mother, Lisa believes that health care and a healthy lifestyle are intrinsically linked and that each serves to support the other. Dr. Watson practices at the Integrative Health Institute in Downtown Toronto.

Check out Dr Watson’s blog: www.drlisawatson.com