Endometriosis and Fertility
February 28, 2025 No Comments
Endometriosis affects an estimated 200 million people worldwide.
Endometriosis can make it more difficult to get pregnant — between 30-50% of people with endometriosis may experience infertility.
The normal chance of getting pregnant each month for people with no endometriosis is approximately 10-20%, while people with surgically documented endometriosis have a chance of only 1-10%.
Those statistics are crazy. And a little heartbreaking.
March is Endometriosis Awareness Month, making it an incredible opportunity for all women to understand more about this condition, what symptoms to look for, how it affects their fertility, and how to naturally prepare their bodies for conception, despite having endometriosis.
Here’s the thing —
You can conceive and deliver a baby if you’re living with endometriosis — it is possible!
Keep reading to find out everything you need to know if you’re trying to get pregnant while living with endometriosis.
Endometriosis involves an estrogen‐dependent inflammatory process of the pelvic tissues leading to chronic pelvic pain and infertility, although some individuals are asymptomatic. The tissue that lines the uterus is called the endometrium. Normally, if a woman doesn’t get pregnant, this tissue is shed each month during her period. In endometriosis, endometrial‐like tissue is found outside of the uterine cavity – on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity. This displaced endometrial-like tissue can lead to symptoms such as superficial peritoneal lesions, ovarian cysts, deep penetrating nodules, or extra‐pelvic lesions.
Endometriosis may impact areas in the pelvis and beyond, including the bladder, ureter, bowel, deep pelvic nerves, anterior abdominal wall, diaphragm, lungs, pericardium, and brain.
Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle. It builds up, breaks down, and bleeds — but the blood has nowhere to go. This causes surrounding tissue to become inflamed or swollen. It can also cause scar tissue, chronic pain, and heavy periods.
Endometriosis is a main cause of infertility in women. This can happen if the tissue implants in the ovaries or fallopian tubes. Tissue can also implant on other organs in the pelvis and, in some cases, outside the pelvis.
The cause of endometriosis is not clear. It may be that during a woman’s period, some of the tissue backs up through the fallopian tubes into the belly. These cells can implant in the pelvis or be transported through the bloodstream or lymphatics to other parts of the body. Another theory suggests genes are to blame resulting in cells transforming into endometrial tissue. Current research is also looking at the role of the immune system.
Any woman may develop endometriosis, but the following women seem to be at an increased risk for the disease:
Each woman may experience symptoms differently, but these are the most common symptoms:
The amount of pain a woman has isn’t always related to the severity of the disease. Some women with severe disease may have no pain, other women with a milder form of the disease may have severe pain or other symptoms.
Studies have shown that the amount of endometriosis that is seen at the time of laparoscopy — a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen — is linked to future fertility. There is a staging system for evaluating endometriosis:
Stage I (minimal disease): There are few small implants (specs) of endometriosis, with no scar tissue seen.
Stage II (mild disease): There are more implants of endometriosis, but less than 2 inches of the abdomen is involved and there is no scar tissue.
Stage III (moderate disease): There is quite a bit of endometriosis in the abdomen which may be deep and may create pockets of endometriotic fluid (chocolate cysts, or endometriomas) in the ovaries. There may be scar tissue around the tubes or ovaries.
Stage IV: A great deal of endometriotic implants, possibly large endometriotic cysts in the ovaries, possible scar tissue between the uterus and the rectum (lower part of the intestines), and around the ovaries or fallopian tubes.
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting — and staying — pregnant. These are the main ways that endometriosis can affect fertility:
Inflammation and scarring: can lead to blocked fallopian tubes or ovarian cysts (endometriomas).
Distorted pelvic anatomy: adhesions may disrupt egg transport and implantation.
Hormonal imbalances: can lead to poor egg quality and an inhospitable uterine environment.
Immune dysfunction: increased inflammatory markers may prevent successful implantation.
Ovarian reserve decline: endometriosis can negatively affect AMH (Anti-Müllerian Hormone) levels. AMH is primarily used as a marker to estimate the number of eggs a woman has left in her ovaries.
Lower fertilization rates: egg-sperm interaction may be impaired.
Changes in progesterone levels: can affect luteal phase support (important for implantation).
Endometriosis may increase your risk for pregnancy and delivery complications. This may be caused by the inflammation, structural damage to the uterus, and hormonal influences endometriosis causes.
Women with endometriosis have a higher risk of preterm birth, preeclampsia, and placental abnormalities.
Studies suggest higher miscarriage rates due to uterine inflammation and hormonal imbalances, and an increased risk of ectopic pregnancy if the fallopian tubes are affected.
Currently, there is no evidence that medication can improve a person’s chances of getting pregnant with endometriosis; however your doctor may prescribe medications, such as progesterone, to increase the amount of progesterone hormone in your body to counteract estrogen.
It’s also important to live as healthy a lifestyle as possible when you have endometriosis and are trying to get pregnant — this can reduce inflammation in your body which will help your body be ready and prepared to successfully conceive and carry a healthy full term pregnancy.
As with any major diet and lifestyle changes, it can take up to 6-12 months of consistent change, along with natural therapies to bring about real change in the body when trying to conceive with endometriosis. Here’s how you can improve your chances of getting pregnant with endometriosis:
When attempting to prepare your body for conception with endometriosis, it’s important to adopt an anti‐inflammatory, antioxidant‐rich eating pattern. Inflammation and oxidative stress both play roles in endometriosis. Begin by eliminating the foods that cause inflammation in the body:
Additionally, it’s important to follow an anti-inflammatory diet when dealing with endometriosis. That means it’s a good idea to add in lots of beneficial antioxidant-rich foods:
Consume cruciferous vegetables, as certain phytochemicals in these plants have been shown to support a healthy estrogen metabolism, a healthy inflammatory response, and endometriosis. This includes broccoli, Brussels sprouts, cabbage, bok choy, kale, cauliflower, and collard greens.
In addition, you can reduce inflammation and regulate hormone production by increasing your intake of healthy fats & plenty of essential fatty acids:
Consider a gluten‐free trial period of 4 to 8 weeks, as this has been shown to promote a healthy response to pain and inflammation for patients with endometriosis.
It’s easy to be overwhelmed with supplements options when it comes to treating endometriosis, but don’t worry, that’s where I come in! I’ve rounded up my favorite supplements to help ease the pain and discomfort associated with endometriosis, reduce excess estrogen in the body (which is essential when dealing with endometriosis), and provide plenty of antioxidants:
OmegAvail Hi-Po: Several studies have found that omega-3 fatty acids may be beneficial for women with endometriosis as it can decrease your levels of an inflammatory chemical called prostaglandin E2. Researchers also found that fish oil can slow the growth of endometrial tissue.
Cal/Mag: The combination of calcium and magnesium together helps the liver more efficiently metabolize excess estrogen and other hormones. Magnesium is also important for optimizing progesterone levels.
DIM-Evail: DIM (diindolylmethane), is a compound that helps to support healthy estrogen metabolism. Endometriosis is an estrogen dominant condition so by supporting detoxification of excess estrogens, DIM can help prevent endometrial tissue from growing.
Inflammatone: Inflammatone contains a blend of proteolytic enzymes. Enzyme therapy is one of the best and most effective natural treatments for endometriosis. Specific enzymes can reduce the scar tissue and digest the excess tissues left from endometriosis. Enzyme therapy also aids women who have endometriosis by reducing the inflammation caused from the scar tissue irritating the surrounding organs and may help with the pain that sometimes comes from having endometriosis. The blood cleansing actions of enzymes help to bring proper circulation to the reproductive system and get the “stagnant blood” cleared out, bringing fresh oxygenated blood to your uterus and ovaries.
BroccoProtect: BroccoProtect is a synergistic blend of specially cultivated broccoli seed extract and mustard seed powder (Sinapis alba) concentrate. BroccoProtect is designed to help support detoxification pathways, antioxidant status, healthy estrogen metabolism, and cellular health.
Lifestyle changes are some of the most effective ways to help with endometriosis symptoms and prepare your body for conception. The following lifestyle suggestions compliment your dietary and nutrition changes.
Exercise boosts production of our feel good hormones, anti-inflammatory chemicals, improves estrogen metabolism by the liver, and burns fat.
Less fat = less estrogen = less pain.
Thirty to sixty minutes of daily, low impact movement – yoga, power walking, swimming, strength training, hiking, running, biking, etc – will get your heart rate up, increase circulation to your reproductive organs, and help you improve overall physical and mental health. Yoga, in particular, has been identified as beneficial for pelvic pain.
It’s important to reduce or eliminate exposure to bisphenol A (BPA) and other endocrine disruptors with estrogenic properties. Start switching all your home and body care products to non-toxic, chemical-free, fertility and pregnancy safe products.
Eliminate all plastic from your kitchen. Don’t drink out of plastic water bottles. Avoid canned goods, only buy brands that specify “BPA-free”.
Handle paper receipts as little as possible and wash your hands afterwards.
Avoid using perfume, hairspray, and nail polish.
Always use organic tampons. An even better option is switching to a Diva Cup —a reusable, bell-shaped menstrual cup that is worn internally and sits low in the vaginal canal, collecting rather than absorbing your menstrual flow.
Look for cleaning and laundry products that are plant-based, fragrance-free, or phthalate-free.
Consider whether there is anything in your home made out of soft, flexible plastic, such as vinyl or PVC, that can be replaced with a safer alternative.
Throw away all non-stick Teflon-type cookware. Cook only in cast iron, stainless steel, glass or ceramic.
A castor oil pack is a cloth soaked in castor oil which is placed on the skin to enhance circulation and promote healing of the tissues and organs underneath the skin. Castor oil packs are very helpful for women with endometriosis because they can clear out old tissue and congestion. Castor oil packs are also very beneficial for breaking up scar tissue.
To support hormone health, reduce scar tissue, and make your womb habitable, I recommend clients place the cloth soaked in castor oil on your lower abdomen, where your ovaries and uterus live. You can also place the cloth over your liver to support optimal hormone detoxification as well.
To make a castor oil pack, you’ll need: unrefined castor oil, plastic wrap (piece large enough to cover your entire abdomen), an old white cotton t-shirt, pillowcase or piece of flannel fabric (preferably organic and large enough to cover abdomen), a heating pad (not electric) or hot water bottle, and an old sheet or towel.
Here’s what to do:
Store the pack in your fridge in a large zip lock bag. Reuse the oil and pack several times. Add more oil as needed to keep the pack well saturated. Replace the pack after it begins to change color. This may occur in days, weeks, or months.
The castor oil pack will be most effective when left on for 60-90 minutes and done for 4 or 5 consecutive days per week.
Note: Don’t use castor oil packs while menstruating and, if you’re actively trying to conceive, don’t do it after ovulation.
Progesterone is thought to slow the growth of abnormal endometrial tissue. Although it’s not considered a cure, it may increase your chances of conception with endometriosis.
When using bioidentical progesterone, It’s important to be supervised and to have progesterone levels monitored because too much progesterone can cause side effects such as mood changes, depression, water retention, weight gain, and absent or abnormal menstrual bleeding.
To read more about dosing and how bioidentical progesterone works, check out: Using Bioidentical Progesterone to Naturally Increase Progesterone Levels.
Chronic stress is greatly associated with endometriosis and may exacerbate symptoms. Cortisol is a hormone involved in the stress response but is also needed to make other hormones such as progesterone. Prolonged stress can lead to elevations in cortisol, which practitioners say may decrease the available progesterone and result in estrogen dominance.
The present world is filled with stress, that’s non-negotiable. But how you respond and react to stress is entirely in your control. Practice managing your daily stressors with ease. My favorite tools for this are: restorative yoga, long slow walks in nature, biofeedback, a hot bath, a massage, or whatever else brings your unique soul pleasure!
Pelvic massage, also known as Maya Abdominal Massage or Uterine Massage, helps the body with congestive issues like endometriosis. When endometrial tissues begin to grow in other areas of the body besides the uterus, irritation occurs which then can create scar tissue. This in turn can cause organs to begin to become stuck together by the scar tissue and tight fascia. It may also cause fallopian tubes to begin to twist. Massage can be used to help break up the adhesions, decrease the inflammation, and help the body to rid itself of the old blood left from the endometrial tissues.
Having endometriosis may make it more difficult to conceive, and may also increase your risk for serious pregnancy complications.
However, getting pregnant and having a healthy baby are possible and common with endometriosis.
Endometriosis and Infertility: How and When to Treat?
Endometriosis and pregnancy (and breastfeeding)
Endometriosis, especially mild disease: a risk factor for miscarriages
Trends in the incidence, rate and treatment of miscarriage—nationwide register-study in Finland, 1998–2016 | Human Reproduction | Oxford Academic
Endometriosis | Office on Women’s Health
Endometriosis increases the risk of obstetrical and neonatal complications
Regulation of Inflammation Pathways and Inflammasome by Sex Steroid Hormones in Endometriosis
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Sarah Jane Sandy is a certified nutrition therapist, and a fertility and women’s health expert. She has helped hundreds of women increase their fertility naturally and go on to have healthy full-term pregnancies. She has been working with women and couples trying to get pregnant for over 16 years and over 90% of the women who work with her get pregnant and have healthy babies.
She also works with women trying to fix their hormone imbalances, as well as supporting women through pregnancy and the postpartum period. Learn more about her own fertility and hormone journey here. To send Sarah a message, complete her Contact Form.
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